Healthcare Provider Details

I. General information

NPI: 1093407736
Provider Name (Legal Business Name): MASON CHARLES DONAHUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LONGFELLOW ST STE 200
VANDERGRIFT PA
15690-1476
US

IV. Provider business mailing address

224 LONGFELLOW ST STE 200
VANDERGRIFT PA
15690-1476
US

V. Phone/Fax

Practice location:
  • Phone: 724-568-5551
  • Fax: 724-568-3137
Mailing address:
  • Phone: 724-568-5551
  • Fax: 724-568-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP031385
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: