Provider Demographics
NPI:1457300733
Name:DONER, IVAN A (DO)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:A
Last Name:DONER
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:P. O. BOX 8500 - 6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:10101 ACADEMY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1120
Practice Address - Country:US
Practice Address - Phone:215-632-4000
Practice Address - Fax:215-632-1661
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002544L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18170OtherHEALTH PARTNERS
PA19193OtherAETNA
PA3235OtherCLEARCARE
PA049399OtherHIGHMARK BLUE SHIELD
PA1103032OtherCIGNA
PA0007121900003Medicaid
PA0057944000OtherIBC,KEYSTONE
PAPA0049560OtherTRICARE
PA1025952OtherKEYSTONE MERCY
PA810159625OtherPHCS
PA049399OtherPERSONAL CHOICE
PA408040OtherUNITED HEALTHCARE
PA0007121900004Medicaid
PA00712190-02OtherAMERICHOICE
PA080104782OtherRAILROAD MEDICARE
PA0007121900001Medicaid
PA0007121900003Medicaid
PA0007121900001Medicaid