Provider Demographics
NPI:1942208921
Name:DONOVAN, MICHAEL PRESCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PRESCOTT
Last Name:DONOVAN
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 1:161 WORCESTER RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5352
Mailing Address - Country:US
Mailing Address - Phone:508-370-7703
Mailing Address - Fax:508-370-7701
Practice Address - Street 1:161 WORCESTER RD
Practice Address - Street 2:SUITE 601
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5352
Practice Address - Country:US
Practice Address - Phone:508-370-7703
Practice Address - Fax:508-370-7701
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80967208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3137945Medicaid
G06171Medicare UPIN
MAJ31217Medicare ID - Type Unspecified