Provider Demographics
NPI:1417147638
Name:DONALD H PRITCHARD MD PA
Entity Type:Organization
Organization Name:DONALD H PRITCHARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:443-869-5365
Mailing Address - Street 1:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1442
Mailing Address - Country:US
Mailing Address - Phone:443-869-5365
Mailing Address - Fax:
Practice Address - Street 1:9030 W FORT ISLAND TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2412
Practice Address - Country:US
Practice Address - Phone:352-564-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660114600Medicaid
FL108921Medicare UPIN