Provider Demographics
NPI:1902864002
Name:PHELAN, DONNA K (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:PHELAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:KERMANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7 SOUTHWOODS BLVD
Mailing Address - Street 2:CAPITAL CARDIOLOGY ASSOCIATES PC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2526
Mailing Address - Country:US
Mailing Address - Phone:518-292-6000
Mailing Address - Fax:518-292-6050
Practice Address - Street 1:7 SOUTHWOODS BLVD
Practice Address - Street 2:CAPITAL CARDIOLOGY ASSOCIATES PC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2526
Practice Address - Country:US
Practice Address - Phone:518-292-6000
Practice Address - Fax:518-292-6050
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220731207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02775368Medicaid
VT1015881Medicaid
NYP00392568OtherRR MEDICARE
MA2119765Medicaid
NYP00392568OtherRR MEDICARE
NYRB0538Medicare PIN
NYJ400004401Medicare PIN