Basic Information
| Provider Information | |||||||||
| NPI: | 1710989322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONEGAN | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64584 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107874897 | ||||||||
| FaxNumber: | 4105951933 | ||||||||
| Practice Location | |||||||||
| Address1: | 7550 TEAGUE RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210761339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107874897 | ||||||||
| FaxNumber: | 4105951933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 12/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0068818 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 152599ZEZT | 01 | MD | MEDICARE PTAN | OTHER | 950201 | 01 | MD | CAREFIRST RENDERING NUMBER | OTHER | 165767 | 01 | MD | MEDICARE GROUP PTAN | OTHER | Q818-0019 | 01 | CAREFIRST | OTHER | 022452900 | 05 | MD | MEDICAID |