Provider Demographics
NPI:1053663732
Name:M.K. DOVNARSKY,M.D.,P.C.
Entity Type:Organization
Organization Name:M.K. DOVNARSKY,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DOVNARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:856-297-0238
Mailing Address - Street 1:48 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3023
Mailing Address - Country:US
Mailing Address - Phone:856-297-0238
Mailing Address - Fax:888-357-3184
Practice Address - Street 1:48 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3023
Practice Address - Country:US
Practice Address - Phone:856-297-0238
Practice Address - Fax:888-357-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04409900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty