Provider Demographics
NPI:1659478428
Name:DONOVAN, DEIRDRE EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:EILEEN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DEIRDRE
Other - Middle Name:DONOVAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1583
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:310 AVON ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5750
Practice Address - Country:US
Practice Address - Phone:434-817-1818
Practice Address - Fax:434-817-9606
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01227535Medicare PIN
I34628Medicare UPIN
VAVV3906AMedicare PIN