Provider Demographics
NPI:1891729372
Name:DOVNARSKY, MICHAEL KEITH (MD, FCCP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEITH
Last Name:DOVNARSKY
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1206 W SHERMAN AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6916
Mailing Address - Country:US
Mailing Address - Phone:856-692-7700
Mailing Address - Fax:856-213-5403
Practice Address - Street 1:1206 W SHERMAN AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6916
Practice Address - Country:US
Practice Address - Phone:856-691-8444
Practice Address - Fax:856-691-8325
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44099207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5473900Medicaid
NJC69330Medicare UPIN
NJ563401Medicare ID - Type Unspecified