Provider Demographics
NPI:1932136876
Name:DONOHUE, THOMAS WILLIAM (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORNERSTONE COURT
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1550
Mailing Address - Country:US
Mailing Address - Phone:860-276-8140
Mailing Address - Fax:860-628-0278
Practice Address - Street 1:15 CORNERSTONE COURT
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1550
Practice Address - Country:US
Practice Address - Phone:860-276-8140
Practice Address - Fax:860-628-0278
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000398213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004066908Medicaid
CT480000311Medicare ID - Type Unspecified
CT004066908Medicaid