Provider Demographics
NPI:1194740399
Name:DONSHIK, PETER CLIFFORD (MD,)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CLIFFORD
Last Name:DONSHIK
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 1:47 JOLLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3092
Mailing Address - Country:US
Mailing Address - Phone:860-286-5448
Mailing Address - Fax:860-286-5549
Practice Address - Street 1:47 JOLLEY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3092
Practice Address - Country:US
Practice Address - Phone:860-286-5448
Practice Address - Fax:860-286-5549
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT180000820Medicare ID - Type Unspecified