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NPI Code Detail

MEDICARE: CARLY DONAHUE DO

MEDICARE: CARLY DONAHUE DO
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 Physician191485NC
2207Q00000XFamily Medicine Physician2015-02035NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1191485OTHERNCRESIDENT TRAINING LICENSE NUMBER

General Provider Information

NPI Number : 1790121796
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY DONAHUE DO
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2610 W ARROWOOD RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-6134
Country : US
Telephone Number : 704-316-1700
Fax Number : 704-316-1701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2013
Last Update Date : 03/07/2023

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Directions to “ CARLY DONAHUE DO” Practice Location

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