Provider Demographics
NPI:1558445171
Name:CHAMOFF, DONNA M (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:CHAMOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8434
Mailing Address - Country:US
Mailing Address - Phone:207-883-0711
Mailing Address - Fax:207-883-2204
Practice Address - Street 1:200 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8434
Practice Address - Country:US
Practice Address - Phone:207-883-0711
Practice Address - Fax:207-883-2204
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER023280363LP0808X
MECNP81783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP551901Medicare PIN
MENP551903Medicare PIN