Provider Demographics
NPI:1356402853
Name:DONATI, JEAN T (PA-C, LAC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:T
Last Name:DONATI
Suffix:
Gender:F
Credentials:PA-C, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 ROFERD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2929
Mailing Address - Country:US
Mailing Address - Phone:410-984-3700
Mailing Address - Fax:
Practice Address - Street 1:604 E. JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5421
Practice Address - Country:US
Practice Address - Phone:410-984-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01451363A00000X
MDU00953171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8430012-00OtherMEDICAL ASSISTANCE PROGRAM