Provider Demographics
NPI:1790722304
Name:DONAHOE, SEAN M (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:DONAHOE
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 1:951 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2724
Mailing Address - Country:US
Mailing Address - Phone:631-369-5005
Mailing Address - Fax:631-369-4994
Practice Address - Street 1:951 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2724
Practice Address - Country:US
Practice Address - Phone:631-727-7773
Practice Address - Fax:631-727-7832
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224079207R00000X
NY240329207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03114550Medicaid
NY03114550Medicaid