MEDICARE: MR. CHRISTOPHER F DONOVIN PA

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	102817	NC

General Provider Information

NPI Number	:	1649221359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER F DONOVIN PA

Provider Business Mailing Address
First Line	:	128 WETLAND DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2726
Country	:	US
Telephone Number	:	910-409-0922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632-3 CAROLINA BEACH ROAD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-1806
Country	:	US
Telephone Number	:	910-409-0922
Fax Number	:	910-794-3938

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/25/2011

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