Provider Demographics
NPI:1497795405
Name:DONOVAN, JANET (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE G40
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3068
Mailing Address - Country:US
Mailing Address - Phone:206-244-6625
Mailing Address - Fax:206-244-6726
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:STE G40
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-244-6625
Practice Address - Fax:206-244-6726
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF15933Medicare UPIN