Provider Demographics
NPI:1316912413
Name:DONNINI, RICHARD M (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:DONNINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 YANKEE PARK PL
Mailing Address - Street 2:STE A
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1838
Mailing Address - Country:US
Mailing Address - Phone:937-439-4949
Mailing Address - Fax:397-439-4948
Practice Address - Street 1:1550 YANKEE PARK PL
Practice Address - Street 2:STE A
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1838
Practice Address - Country:US
Practice Address - Phone:937-439-4949
Practice Address - Fax:397-439-4948
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003971208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0782550Medicaid
E33626Medicare UPIN
OHDO0657712Medicare PIN