Provider Demographics
NPI:1114026671
Name:DONOHOE, REBECCA J
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:DONOHOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:THS PHYSICIAN PARTNERS, INC.-ADMINISTRATIVE OFC.
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:304-414-4801
Practice Address - Street 1:4820 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1310
Practice Address - Country:US
Practice Address - Phone:304-720-0390
Practice Address - Fax:304-720-0391
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB441OtherGROUP MEDICARE
WV1114026671Medicaid
WV3810024049OtherGROUP MEDICAID
WV3810024049OtherGROUP MEDICAID
Q56183Medicare UPIN