Basic Information
Provider Information | |||||||||
NPI: | 1780794206 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DONOHOE | ||||||||
FirstName: | JEFFREY | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7234 CASTLE PINE DR | ||||||||
Address2: |   | ||||||||
City: | SOLON | ||||||||
State: | OH | ||||||||
PostalCode: | 441395247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7065649101 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9500 EUCLID AVE | ||||||||
Address2: | Q10-217 | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441955503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2166369483 | ||||||||
FaxNumber: | 2164452267 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2006 | ||||||||
LastUpdateDate: | 01/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 056280 | GA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208800000X | 056280 | GA | N |   | Allopathic & Osteopathic Physicians | Urology |   | 2088P0231X | 56280 | GA | N |   | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 2088P0231X | ME143435 | FL | Y |   | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
No ID Information.