Provider Demographics
NPI:1093878522
Name:DONOVAN, JOHN- PAUL (CPO)
Entity type:Individual
Prefix:MR
First Name:JOHN- PAUL
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2111
Mailing Address - Country:US
Mailing Address - Phone:207-774-1002
Mailing Address - Fax:207-774-9002
Practice Address - Street 1:1274 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2111
Practice Address - Country:US
Practice Address - Phone:207-774-1002
Practice Address - Fax:207-774-9002
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME007654OtherANTHEM
ME007654OtherANTHEM