Provider Demographics
NPI:1275798282
Name:DONOVAN, MICHAEL SHAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2900 LAMB CIR STE 301
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6345
Mailing Address - Country:US
Mailing Address - Phone:540-731-2328
Mailing Address - Fax:540-639-3950
Practice Address - Street 1:2900 LAMB CIR STE 301
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6345
Practice Address - Country:US
Practice Address - Phone:540-731-2328
Practice Address - Fax:540-639-3950
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2018-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102205115207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN