Basic Information
| Provider Information | |||||||||
| NPI: | 1073806865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONOHOE | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E KINCAID ST | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604282500 | ||||||||
| FaxNumber: | 3604286485 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 E KINCAID ST | ||||||||
| Address2: | HOSPITALISTS OFFICE | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604165750 | ||||||||
| FaxNumber: | 3604165758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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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 | 207R00000X | A120494 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD60465597 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.