Provider Demographics
NPI:1679624985
Name:DONOVAN, DENISE PAULINE (PA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:PAULINE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:501 FAIRMOUNT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5457
Mailing Address - Country:US
Mailing Address - Phone:410-494-7920
Mailing Address - Fax:410-902-8247
Practice Address - Street 1:515 FAIRMOUNT AVE STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1662
Practice Address - Fax:410-494-1718
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD90120Medicare UPIN
MDJ006Medicare ID - Type Unspecified