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NPI Code Detail

MEDICARE: MARY M DONOFRIO M.D.

MEDICARE: MARY M DONOFRIO 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
1207Q00000XFamily Medicine Physician35083907OH

General Provider Information

NPI Number : 1740371285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY M DONOFRIO M.D.
Provider Business Mailing Address
First Line : 30 E BROAD ST
Second Line : 11TH FL. ATTN: TONYA FASONE
City : COLUMBUS
State : OH
Zip : 43215-3414
Country : US
Telephone Number : 614-466-9930
Fax Number : 614-644-9116
Provider Business Practice Location Address
First Line : 1708 SOUTHPOINT DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1911
Country : US
Telephone Number : 216-787-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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