Provider Demographics
NPI:1164409918
Name:DONAHUE, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:DONAHUE
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 1:150 E MANNING ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5109
Mailing Address - Country:US
Mailing Address - Phone:401-272-2020
Mailing Address - Fax:401-421-5979
Practice Address - Street 1:150 E MANNING ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5109
Practice Address - Country:US
Practice Address - Phone:401-272-2020
Practice Address - Fax:401-421-5979
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10345207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJ22516OtherMASS BLUE SHIELD
RI0800704OtherUNITED
RI0859OtherNHP RI GROUP #
RI205714OtherTUFTS
RI7008251Medicaid
RI152346OtherHARVARD
RI26587OtherRI BLUE SHIELD
RI3805OtherNEIGHBORHOOD RI
RI5841743OtherAETNA
RI9001520Medicaid
RI1566940OtherCIGNA
RI603940OtherTUFTS GROUP #
RI407086OtherBLUE CHIP
MAM17477OtherBCBS MASS GROUP #
RI180042875OtherRAILROAD MEDICARE
RI7008251Medicaid
RI189002658Medicare PIN
RI007008251Medicare PIN