Provider Demographics
NPI:1710989322
Name:DONEGAN, SAMUEL P (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:P
Last Name:DONEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64584
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4584
Mailing Address - Country:US
Mailing Address - Phone:410-787-4897
Mailing Address - Fax:410-595-1933
Practice Address - Street 1:7550 TEAGUE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1339
Practice Address - Country:US
Practice Address - Phone:410-787-4897
Practice Address - Fax:410-595-1933
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068818207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152599ZEZTOtherMEDICARE PTAN
MD950201OtherCAREFIRST RENDERING NUMBER
MD165767OtherMEDICARE GROUP PTAN
Q818-0019OtherCAREFIRST
MD022452900Medicaid
Q818-0019OtherCAREFIRST