Provider Demographics
NPI:1124061981
Name:DONOVAN, ANNE T (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:TAYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-485-4116
Mailing Address - Fax:859-485-1389
Practice Address - Street 1:13260 SERVICE RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094
Practice Address - Country:US
Practice Address - Phone:859-485-4116
Practice Address - Fax:859-485-1389
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64050966Medicaid
KYP00839842OtherRAILROAD MEDICARE
OH2324032Medicaid
KY080189358OtherRAILROAD MEDICARE
KYP00839842OtherRAILROAD MEDICARE
KY080189358OtherRAILROAD MEDICARE
KY0400025Medicare PIN