Provider Demographics
NPI:1427082940
Name:DONOHUE, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:A
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:506 GRAHAM DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3346
Mailing Address - Country:US
Mailing Address - Phone:281-378-5270
Mailing Address - Fax:281-378-5272
Practice Address - Street 1:506 GRAHAM DR
Practice Address - Street 2:SUITE 230
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3346
Practice Address - Country:US
Practice Address - Phone:281-378-5270
Practice Address - Fax:281-378-5272
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20898208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015629OtherWEST VIRGINIA MEDICAID FOR NPI GROUP # 1255586855
KY64208986Medicaid
KY00802OtherMEDICARE GROUP/ORGANIZATION PTAN #
KY1255586855OtherMEDICARE GROUP/ORGANIZATION NPI #
KY00802OtherMEDICARE GROUP/ORGANIZATION PTAN #
WV3810015629OtherWEST VIRGINIA MEDICAID FOR NPI GROUP # 1255586855
KY64208986Medicaid