Provider Demographics
NPI:1649213760
Name:DONALDSON, CARLENE I (MS PT)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:I
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:I
Other - Last Name:JEROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 419666
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9666
Mailing Address - Country:US
Mailing Address - Phone:410-970-8190
Mailing Address - Fax:410-313-8314
Practice Address - Street 1:9135 PISCATAWAY RD STE 305
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2554
Practice Address - Country:US
Practice Address - Phone:301-877-2323
Practice Address - Fax:301-877-2366
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8825 - 0025OtherCAREFIRST