Provider Demographics
NPI:1346237559
Name:DONOHUE, ANDREW W (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HARLECH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2508
Mailing Address - Country:US
Mailing Address - Phone:302-999-7386
Mailing Address - Fax:302-999-7386
Practice Address - Street 1:1415 FOULK RD STE 104
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2748
Practice Address - Country:US
Practice Address - Phone:302-478-1450
Practice Address - Fax:302-478-1430
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00079312084P0800X, 2084F0202X
MDH00587032084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86308Medicare UPIN
A35492Medicare ID - Type Unspecified