Provider Demographics
NPI:1346235579
Name:DONLAN, CHARLES J JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:DONLAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 2200
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-645-3460
Practice Address - Fax:757-645-3481
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-04-30
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Provider Licenses
StateLicense IDTaxonomies
VA0101020552207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346235579Medicaid
VA1346235579Medicaid
VAB06813Medicare UPIN