Provider Demographics
NPI:1912948787
Name:DONOGHUE, DONNA O (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:O
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 HORSEBLOCK RD STE H
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1252
Mailing Address - Country:US
Mailing Address - Phone:631-233-9490
Mailing Address - Fax:
Practice Address - Street 1:400 HORSEBLOCK RD STE H
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1252
Practice Address - Country:US
Practice Address - Phone:631-233-9490
Practice Address - Fax:631-233-9499
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2085902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144392Medicaid
NY02144392Medicaid
NYH34410Medicare UPIN