Provider Demographics
NPI:1023199619
Name:DONAHUE, MARTIN ANDREW (PHD, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ANDREW
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ADAMS AVE
Mailing Address - Street 2:DEPARTMENT OF HEALTH AND PHYSICAL EDUCATION
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1514
Mailing Address - Country:US
Mailing Address - Phone:570-348-6259
Mailing Address - Fax:
Practice Address - Street 1:215 ELECTRIC ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1933
Practice Address - Country:US
Practice Address - Phone:570-586-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0036642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer