Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | G55336 | CA |
Y | 2086S0129X | Vascular Surgeon | MD444690 | PA |
NPI | 1134191752 |
---|---|
Provider Name | Carlos Donayre |
First Address | York, PA 17402-9001 |
Second Address | Ephrata, PA 17522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 04/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G553360 | (05) | CA |
F38965 | (02) | CA |