Provider Demographics
NPI:1811964133
Name:PARKES, DONOVAN (MD)
Entity type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:
Last Name:PARKES
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 1:17 DEEP POWDER CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1110
Mailing Address - Country:US
Mailing Address - Phone:410-591-5869
Mailing Address - Fax:
Practice Address - Street 1:8507 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4833
Practice Address - Country:US
Practice Address - Phone:410-496-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD479931300Medicaid
MD479931300Medicaid