Provider Demographics
NPI:1194838086
Name:DONAHUE, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:DONAHUE
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 1:745 BOYLSTON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2657
Mailing Address - Country:US
Mailing Address - Phone:617-585-1500
Mailing Address - Fax:617-585-1515
Practice Address - Street 1:745 BOYLSTON ST STE 600
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2657
Practice Address - Country:US
Practice Address - Phone:617-585-1500
Practice Address - Fax:617-585-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE74419Medicare UPIN
MAA39553Medicare ID - Type Unspecified