Provider Demographics
NPI:1477514727
Name:DONOVAN, GINA M (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 ROUTE 981
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5397
Mailing Address - Country:US
Mailing Address - Phone:724-532-1118
Mailing Address - Fax:724-532-1307
Practice Address - Street 1:5840 ROUTE 981
Practice Address - Street 2:SUITE 101
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5397
Practice Address - Country:US
Practice Address - Phone:724-532-1118
Practice Address - Fax:724-532-1307
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050988363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
078323Medicare ID - Type Unspecified
PA122418U6VMedicare PIN
P85250Medicare UPIN
PAP00268880Medicare PIN