Provider Demographics
NPI:1942305990
Name:DONDERSHINE, HARVEY EDWARD (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:EDWARD
Last Name:DONDERSHINE
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1857
Mailing Address - Country:US
Mailing Address - Phone:650-906-0887
Mailing Address - Fax:650-321-0888
Practice Address - Street 1:407 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1857
Practice Address - Country:US
Practice Address - Phone:650-906-0887
Practice Address - Fax:650-321-0888
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC339492084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC33949OtherMEDICAL LICENSE
CAC33949OtherMEDICAL LICENSE