Provider Demographics
NPI:1891878807
Name:DONATELLI, LUCIA S (MD)
Entity type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:S
Last Name:DONATELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 ABBEYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4932
Mailing Address - Country:US
Mailing Address - Phone:410-931-0222
Mailing Address - Fax:
Practice Address - Street 1:1000 S MARLYN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-5939
Practice Address - Country:US
Practice Address - Phone:410-238-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057396208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI12119Medicare UPIN