Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 011098 | ME |
NPI | 1104872050 |
---|---|
Provider Name | Desmond J. Donegan |
First Address | Falmouth, ME 04105-1379 |
Second Address | Falmouth, ME 04105-1379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 12/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330670099 | (05) | ME |
B86551 | (02) | ME |