Provider Demographics
NPI:1356338255
Name:DONOVAN, DUANE L (MD)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:L
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 1:95 ARCH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-434-4145
Mailing Address - Fax:330-375-4985
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-434-4145
Practice Address - Fax:330-375-4985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0336492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377177Medicaid
OH0845563Medicaid
OH0845563Medicaid
OHAK9934611Medicare ID - Type UnspecifiedGROUP MEDICARE
OHA77717Medicare UPIN