Provider Demographics
NPI:1902804503
Name:DONAHUE, LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT. 441
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-844-5600
Mailing Address - Fax:716-844-5750
Practice Address - Street 1:995 SENATOR KEATING BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2775
Practice Address - Country:US
Practice Address - Phone:585-232-2980
Practice Address - Fax:585-232-6522
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169849208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40426004623OtherFIDELIS
NY912152001OtherHEALTH NOW
NY1131039Medicaid
NY912152001OtherBLUE CROSS BLUE SHEILD
NY26643801OtherUNIVERA
NYMD475HOtherPREFERED CARE
NY1990343OtherINDEPENDENT HEALTH
NY1099197OtherGHI
NY3400004752OtherRR MEDICARE
NY364974OtherWELL CARE
NYMD475HOtherPREFERED CARE
NYE15554Medicare UPIN