MEDICARE: IVAN A. DONER D.O.

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	207Q00000X	Family Medicine Physician	OS002544L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
15	080104782	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18170	OTHER	PA	HEALTH PARTNERS
2	19193	OTHER	PA	AETNA
3	3235	OTHER	PA	CLEARCARE
4	049399	OTHER	PA	HIGHMARK BLUE SHIELD
5	1103032	OTHER	PA	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0057944000	OTHER	PA	IBC,KEYSTONE
8	PA0049560	OTHER	PA	TRICARE
9	1025952	OTHER	PA	KEYSTONE MERCY
10	810159625	OTHER	PA	PHCS
11	049399	OTHER	PA	PERSONAL CHOICE
12	408040	OTHER	PA	UNITED HEALTHCARE
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	00712190-02	OTHER	PA	AMERICHOICE
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457300733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN A. DONER D.O.

Provider Business Mailing Address
First Line	:	P. O. BOX 8500 - 6335
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0001
Country	:	US
Telephone Number	:	215-807-8000
Fax Number	:	215-807-8235

Provider Business Practice Location Address
First Line	:	10101 ACADEMY RD
Second Line	:	SUITE 104
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1120
Country	:	US
Telephone Number	:	215-632-4000
Fax Number	:	215-632-1661

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	06/19/2015

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Directions to “ IVAN A. DONER D.O.” Practice Location

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