Provider Demographics
NPI:1427073451
Name:DONAGHEY, SUSANA IRIAS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:IRIAS
Last Name:DONAGHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 WARD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0556
Mailing Address - Country:US
Mailing Address - Phone:615-904-0134
Mailing Address - Fax:615-904-0136
Practice Address - Street 1:1819 WARD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0556
Practice Address - Country:US
Practice Address - Phone:615-904-0134
Practice Address - Fax:615-904-0136
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10982336OtherCAQH
TN4124400OtherBLUE CROSS PROVIDER NUMBE
TN3826175Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE PROVI
TN4124400OtherBLUE CROSS PROVIDER NUMBE