Provider Demographics
NPI:1538698568
Name:DONOFRIO, DAVID JOHN (APRN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:DONOFRIO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3767
Mailing Address - Country:US
Mailing Address - Phone:440-623-6803
Mailing Address - Fax:
Practice Address - Street 1:6427 STONECREST DR
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3767
Practice Address - Country:US
Practice Address - Phone:440-623-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG04170063207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine