Provider Demographics
NPI:1336189281
Name:TERRENCE K DONAHUE MD LLC
Entity Type:Organization
Organization Name:TERRENCE K DONAHUE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-826-5288
Mailing Address - Street 1:40 HART STREET
Mailing Address - Street 2:BLDG D
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052
Mailing Address - Country:US
Mailing Address - Phone:860-826-5288
Mailing Address - Fax:860-225-9519
Practice Address - Street 1:40 HART STREET
Practice Address - Street 2:BLDG D
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-826-5288
Practice Address - Fax:860-225-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XS0106X
CT028945208600000X
CTID044382208600000X
CT001357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
128945OtherCTC
010028945CT04OtherBCBS
2V4173OtherHEALTHNET
HAS014OtherOXFORD
3460412OtherUHC
HAS014OtherOXFORD