Provider Demographics
NPI:1629035878
Name:DONATO, EDUARDO JR (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:DONATO
Suffix:JR
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:PO BOX 603898
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3898
Mailing Address - Country:US
Mailing Address - Phone:843-679-4221
Mailing Address - Fax:843-679-4268
Practice Address - Street 1:1594 FREEDOM BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505
Practice Address - Country:US
Practice Address - Phone:843-679-4221
Practice Address - Fax:843-679-4268
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC205478Medicaid
SC205478Medicaid
SCG831737958Medicare PIN
SCG83173Medicare UPIN
SCG831736979Medicare PIN