Basic Information
| Provider Information | |||||||||
| NPI: | 1134191752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONAYRE | ||||||||
| FirstName: | CARLOS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 804 GRANDVIEW DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174662500 | ||||||||
| FaxNumber: | 7177337865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | G55336 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD60394714 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD444690 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G553360 | 05 | CA | MEDICAID |