Provider Demographics
NPI:1699876797
Name:DONAHUE, MARK PAUL (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PAUL
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:14 GREYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9362
Mailing Address - Country:US
Mailing Address - Phone:919-401-0786
Mailing Address - Fax:
Practice Address - Street 1:3298 DUMC
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6821
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9900474207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2013477Medicare PIN