Provider Demographics
NPI:1639164346
Name:DONOVAN, MARGARET A (NP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7449 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3973
Mailing Address - Country:US
Mailing Address - Phone:315-451-5400
Mailing Address - Fax:315-451-5422
Practice Address - Street 1:7449 MORGAN RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3973
Practice Address - Country:US
Practice Address - Phone:315-451-5400
Practice Address - Fax:315-451-5422
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303308363LA2200X
NYF333608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02915391Medicaid
NY02915391Medicaid
P86524Medicare UPIN
NYRB8758Medicare PIN