Provider Demographics
NPI:1770886715
Name:DEIRDRE H. DONALDSON, M.D., PLC
Entity type:Organization
Organization Name:DEIRDRE H. DONALDSON, M.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:802-258-6590
Mailing Address - Street 1:19 BELMONT AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7109
Mailing Address - Country:US
Mailing Address - Phone:802-258-6590
Mailing Address - Fax:802-258-6525
Practice Address - Street 1:19 BELMONT AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7109
Practice Address - Country:US
Practice Address - Phone:802-258-6590
Practice Address - Fax:802-258-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00096192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty