Provider Demographics
NPI:1003871799
Name:DONOHUE, TERRENCE P (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:P
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3101 POPLAR LEVEL RD STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1076
Practice Address - Country:US
Practice Address - Phone:502-636-7444
Practice Address - Fax:502-636-7112
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY019323OtherSIHO / NCMA
KY64222805Medicaid
KY000000240980OtherANTHEM / NCMA
IN200464440Medicaid
KY7625694OtherCIGNA / NCMA
KY110242747OtherRAILROAD MEDICARE
KY116617OtherPASSPORT / NCMA
KY000028412BOtherHUMANA / NCMA
KY116617OtherPASSPORT / NCMA
KY000028412BOtherHUMANA / NCMA