Provider Demographics
NPI:1750347985
Name:DONOHUE, MERYETTA HADLEY (DO)
Entity type:Individual
Prefix:
First Name:MERYETTA
Middle Name:HADLEY
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HADLEY
Other - Middle Name:
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:301 UNION AVE # 396
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3249
Mailing Address - Country:US
Mailing Address - Phone:814-515-2797
Mailing Address - Fax:814-515-1445
Practice Address - Street 1:1127 7TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2518
Practice Address - Country:US
Practice Address - Phone:814-515-2797
Practice Address - Fax:814-515-1445
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSO10199L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80833Medicare UPIN