Provider Demographics
NPI:1194838086
Name:DONAHUE, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 NEWBURY ST
Mailing Address - Street 2:6 TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2912
Mailing Address - Country:US
Mailing Address - Phone:617-585-1500
Mailing Address - Fax:617-585-1515
Practice Address - Street 1:137 NEWBURY ST
Practice Address - Street 2:6 TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2912
Practice Address - Country:US
Practice Address - Phone:617-585-1500
Practice Address - Fax:617-585-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE74419Medicare UPIN
MAA39553Medicare ID - Type Unspecified