Provider Demographics
NPI:1811093172
Name:DONMOYER, LORREN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:LORREN
Middle Name:MICHAEL
Last Name:DONMOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-313-2298
Mailing Address - Fax:302-645-3691
Practice Address - Street 1:21635 BIDEN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4574
Practice Address - Country:US
Practice Address - Phone:302-856-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064646207Q00000X
DEC1-0013752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200105010Medicaid
MD1184832040OtherGROUP NPI
MDK230P197Medicare PIN
DE1000040967OtherMEDICAID DELAWARE