MEDICARE: DR. RICHARD F. DONOHUE D.D.S.

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	1223G0001X	General Practice Dentistry	0401004626	VA

General Provider Information

NPI Number	:	1861497091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD F. DONOHUE D.D.S.

Provider Business Mailing Address
First Line	:	10529 BRADDOCK RD
Second Line	:	STE A
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2245
Country	:	US
Telephone Number	:	703-250-2970
Fax Number	:	703-503-2817

Provider Business Practice Location Address
First Line	:	10529 BRADDOCK RD
Second Line	:	STE A
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2245
Country	:	US
Telephone Number	:	703-250-2970
Fax Number	:	703-503-2817

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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