Provider Demographics
NPI:1649221359
Name:DONOVIN, CHRISTOPHER F (PA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:F
Last Name:DONOVIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 WETLAND DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2726
Mailing Address - Country:US
Mailing Address - Phone:910-409-0922
Mailing Address - Fax:
Practice Address - Street 1:2632-3 CAROLINA BEACH ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-1806
Practice Address - Country:US
Practice Address - Phone:910-409-0922
Practice Address - Fax:910-794-3938
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP05860Medicare UPIN