Basic Information
| Provider Information | |||||||||
| NPI: | 1902804503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONAHUE | ||||||||
| FirstName: | LAURENCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | DEPT. 441 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Practice Location | |||||||||
| Address1: | 995 SENATOR KEATING BLVD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852322980 | ||||||||
| FaxNumber: | 5852326522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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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 | 208800000X | 169849 | NY | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 40426004623 | 01 | NY | FIDELIS | OTHER | 912152001 | 01 | NY | HEALTH NOW | OTHER | 1131039 | 05 | NY | MEDICAID | 912152001 | 01 | NY | BLUE CROSS BLUE SHEILD | OTHER | 26643801 | 01 | NY | UNIVERA | OTHER | MD475H | 01 | NY | PREFERED CARE | OTHER | 1990343 | 01 | NY | INDEPENDENT HEALTH | OTHER | 1099197 | 01 | NY | GHI | OTHER | 3400004752 | 01 | NY | RR MEDICARE | OTHER | 364974 | 01 | NY | WELL CARE | OTHER |