Provider Demographics
NPI:1063571032
Name:DONA, SAMUEL MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MIGUEL
Last Name:DONA
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 1:120 SISTER PIERRE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7525
Mailing Address - Country:US
Mailing Address - Phone:410-823-4970
Mailing Address - Fax:410-823-0314
Practice Address - Street 1:120 SISTER PIERRE DR STE 205
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7525
Practice Address - Country:US
Practice Address - Phone:410-823-4970
Practice Address - Fax:410-823-0314
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026844174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD70358Medicare UPIN
MD4202Medicare ID - Type Unspecified