Provider Demographics
NPI:1699011734
Name:CAVANAUGH, DONALD VINCENT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:VINCENT
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:141 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1201
Mailing Address - Country:US
Mailing Address - Phone:724-946-2714
Mailing Address - Fax:724-946-8718
Practice Address - Street 1:141 S MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1201
Practice Address - Country:US
Practice Address - Phone:724-946-2714
Practice Address - Fax:724-946-8718
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant