Provider Demographics
NPI:1669446993
Name:DONALDSON, ANTHONY HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:HERBERT
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:85 KEYES LN
Mailing Address - Street 2:
Mailing Address - City:SHUSHAN
Mailing Address - State:NY
Mailing Address - Zip Code:12873-2915
Mailing Address - Country:US
Mailing Address - Phone:518-854-7492
Mailing Address - Fax:
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-447-6253
Practice Address - Fax:802-442-3017
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0011757208800000X
FLME97441208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA161998331AMedicaid
FL2777584-00Medicaid
FLAB753YMedicare PIN