Provider Demographics
NPI:1922183979
Name:DONATIELLO, ROBERT MARC (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARC
Last Name:DONATIELLO
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 1:125 2ND ST
Mailing Address - Street 2:UNIT #314
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2440 CAMINO RAMON
Practice Address - Street 2:#260
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4383
Practice Address - Country:US
Practice Address - Phone:925-939-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74988207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I02176Medicare UPIN