Provider Demographics
NPI:1528369600
Name:PERSONAL HEALTH MD LLC
Entity Type:Organization
Organization Name:PERSONAL HEALTH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:508-585-1500
Mailing Address - Street 1:137 NEWBURY ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2941
Mailing Address - Country:US
Mailing Address - Phone:617-585-1500
Mailing Address - Fax:617-585-1515
Practice Address - Street 1:137 NEWBURY ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2941
Practice Address - Country:US
Practice Address - Phone:617-585-1500
Practice Address - Fax:617-585-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA39553Medicare PIN
MAE74419Medicare UPIN