Provider Demographics
NPI:1417014887
Name:DONOHUE, CORNELIUS MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:MICHAEL
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 CAMPWOODS RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1029
Mailing Address - Country:US
Mailing Address - Phone:610-293-1969
Mailing Address - Fax:610-293-1969
Practice Address - Street 1:748 CAMPWOODS RD
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1029
Practice Address - Country:US
Practice Address - Phone:610-293-1969
Practice Address - Fax:610-293-1969
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-001995-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0508211Medicaid
PA0508211Medicaid
PAT26993Medicare UPIN