Provider Demographics
NPI:1558322925
Name:DONAHUE, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6781 PARKER FARM DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3161
Mailing Address - Country:US
Mailing Address - Phone:910-763-1555
Mailing Address - Fax:910-762-4726
Practice Address - Street 1:6781 PARKER FARM DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3161
Practice Address - Country:US
Practice Address - Phone:910-763-1555
Practice Address - Fax:910-762-4726
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC018402207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28815OtherBCBS FEDERAL
NC28815OtherBCBS NC
NC28815OtherBCBS STATE
NC406071393OtherRR MEDICARE
NC28815OtherBCBS FEDERAL
NC201491BMedicare PIN