MEDICARE: DR. KEVIN DONOHUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	227115	MA

General Provider Information

NPI Number	:	1225087919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN DONOHUE M.D.

Provider Business Mailing Address
First Line	:	340 MAPLE ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-3200
Country	:	US
Telephone Number	:	508-485-7779
Fax Number	:	508-485-7769

Provider Business Practice Location Address
First Line	:	340 MAPLE ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-3200
Country	:	US
Telephone Number	:	508-485-7779
Fax Number	:	508-485-7769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/13/2013

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Directions to “ DR. KEVIN DONOHUE M.D.” Practice Location

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