Healthcare Provider Details

I. General information

NPI: 1205283447
Provider Name (Legal Business Name): LAUREN KATHERINE DONAHUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 04/23/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 REDGATE AVE
NORFOLK VA
23507-1515
US

IV. Provider business mailing address

9559 BAY POINT DR
NORFOLK VA
23518-2033
US

V. Phone/Fax

Practice location:
  • Phone: 757-866-8656
  • Fax: 757-866-7618
Mailing address:
  • Phone: 480-980-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number0101272699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: