Basic Information
| Provider Information | |||||||||
| NPI: | 1366588907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONOVAN | ||||||||
| FirstName: | ALTHEA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 364 | ||||||||
| Address2: | |||||||||
| City: | LIONVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105241552 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 BLACKHORSE HILL RD | ||||||||
| Address2: | |||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193202040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103847711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD040071L | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0014180930010 | 05 | PA | MEDICAID | 260049964 | 01 | PA | RAILROAD MEDICARE | OTHER | 0650940000 | 01 | PA | PERSONAL CHOICE | OTHER |