Provider Demographics
NPI:1750373445
Name:DONOVAN, EUGENE A (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:A
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:PO BOX 927
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:412 NAMOZINE STREET
Practice Address - Street 2:
Practice Address - City:BURKEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23922
Practice Address - Country:US
Practice Address - Phone:434-767-4822
Practice Address - Fax:434-767-2211
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5161503OtherAETNA
VA345645OtherANTHEM
VA1750373445Medicaid
VA6012060Medicaid
VA00X677C05Medicare PIN
VA6012060Medicaid
VAP00606596Medicare PIN
VA5161503OtherAETNA