Provider Demographics
NPI:1932116324
Name:DONOHUE, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:DONOHUE
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 1:1450 CHAPEL ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-3363
Mailing Address - Fax:203-789-4081
Practice Address - Street 1:1450 CHAPEL ST.
Practice Address - Street 2:SAINT RAPHAEL FACULTY PHYSICIANS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3363
Practice Address - Fax:203-789-4081
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038118207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1932116324Medicaid
CT1932116324Medicaid
P00453917Medicare PIN
E90508Medicare UPIN
CT060001746Medicare PIN