Provider Demographics
NPI:1912033085
Name:DONROVICH, PAUL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:DONROVICH
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 1:401 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1726
Mailing Address - Country:US
Mailing Address - Phone:814-467-0005
Mailing Address - Fax:814-467-8422
Practice Address - Street 1:401 12TH ST
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1726
Practice Address - Country:US
Practice Address - Phone:814-467-0005
Practice Address - Fax:814-467-8422
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018054E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000082091OtherUNISON HEALTH PLANS OF PA
PA0008239110004Medicaid
PA14271OtherUMWA
PA415047Medicare ID - Type Unspecified
PA14271OtherUMWA