Provider Demographics
NPI:1306886163
Name:DONAHUE, TERRENCE K (MD)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:K
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 1:360 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-826-5288
Mailing Address - Fax:860-225-9519
Practice Address - Street 1:40 HART STREET
Practice Address - Street 2:BLDG D
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-826-5288
Practice Address - Fax:860-225-9519
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028945208600000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V4173OtherHEALTHNET
HAS014OtherOXFORD
010028945CT05OtherBLUE SHIELD
3460412OtherUHC
128945OtherCTC
010028945CT05OtherBLUE SHIELD
2V4173OtherHEALTHNET