Provider Demographics
NPI:1548236052
Name:DONAHUE, DEAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MICHAEL
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0969
Mailing Address - Fax:617-726-7667
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:BLK 1570
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-0969
Practice Address - Fax:617-726-7667
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA73115208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA724821OtherTUFTS HEALTH PLAN
MA3164071Medicaid
MAJ17268OtherBCBS MA
MA724821OtherTUFTS HEALTH PLAN
MAA22005Medicare ID - Type Unspecified