Provider Demographics
NPI:1861019408
Name:DONNELL, LINH KIM (PA-C)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:KIM
Last Name:DONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EXECUTIVE PARK DR 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3700
Mailing Address - Country:US
Mailing Address - Phone:518-452-1928
Mailing Address - Fax:518-482-0173
Practice Address - Street 1:2 EXECUTIVE PARK DR 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3700
Practice Address - Country:US
Practice Address - Phone:518-452-1928
Practice Address - Fax:518-482-0173
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT363A00000X
NY025781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1Other1