Provider Demographics
NPI:1578569786
Name:DONALDSON, KAREN M (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 ERDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1720
Mailing Address - Country:US
Mailing Address - Phone:410-558-4800
Mailing Address - Fax:410-675-8947
Practice Address - Street 1:3120 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1720
Practice Address - Country:US
Practice Address - Phone:410-558-4800
Practice Address - Fax:410-675-8947
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09343Medicare UPIN
S732-J042Medicare ID - Type Unspecified