Provider Demographics
NPI:1376591404
Name:DONOVAN, ROBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:DONOVAN
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 1:1 BALTHASER RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9333
Mailing Address - Country:US
Mailing Address - Phone:610-678-1887
Mailing Address - Fax:
Practice Address - Street 1:11 INGOT DR
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9639
Practice Address - Country:US
Practice Address - Phone:610-944-8818
Practice Address - Fax:610-944-7329
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006775E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50044001OtherBLUE CROSS
PA00200400000OtherKEYSTONE EAST
PA5763081OtherAETNA
PA15542OtherBLUE SHIELD
PA015542SX1Medicare ID - Type Unspecified
PA15542OtherBLUE SHIELD