Provider Demographics
NPI:1104872050
Name:DONEGAN, DESMOND J (MD)
Entity type:Individual
Prefix:
First Name:DESMOND
Middle Name:J
Last Name:DONEGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:21 NORTHBROOK DR # B
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1379
Mailing Address - Country:US
Mailing Address - Phone:207-774-5479
Mailing Address - Fax:207-781-3493
Practice Address - Street 1:21 B NORTHBROOK DRIVE
Practice Address - Street 2:MAINE VEIN CENTER ASSOCIATES, LLC
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1379
Practice Address - Country:US
Practice Address - Phone:207-774-5479
Practice Address - Fax:207-781-3493
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME011098208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME330670099Medicaid
ME330670099Medicaid
MEB86551Medicare UPIN