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General NPI Number Information
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NPI Number | 1710989322
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Entity Type | Individual
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Provider Name | SAMUEL P DONEGAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 830 OAK STREET SUITE 223E
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-427-2222
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Fax | 508-897-4773
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVENUE FL 2
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City | BALTIMORE
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D0068818
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 56194
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License Number State | MA
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