Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD14324 | ME |
NPI | 1023102456 |
---|---|
Provider Name | Jon Patrick Donnelly |
First Address | Cape Elizabeth, ME 04107 |
Second Address | Scarborough, ME 04074-7173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 03/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
315420099 | (05) | ME |
G28759 | (02) |