Provider Demographics
NPI:1922048271
Name:ROANE, DONALD CORNELIUS (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CORNELIUS
Last Name:ROANE
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 1:3135 ANCHORAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4303
Mailing Address - Country:US
Mailing Address - Phone:410-268-5686
Mailing Address - Fax:410-268-6780
Practice Address - Street 1:1616 FOREST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1019
Practice Address - Country:US
Practice Address - Phone:410-263-4400
Practice Address - Fax:410-268-5548
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0010698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFP12109Medicaid
MDD75293Medicare UPIN