Provider Demographics
NPI:1700474087
Name:DONKOR, SAMUEL BISMARK
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BISMARK
Last Name:DONKOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WESTMINISTER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3518
Mailing Address - Country:US
Mailing Address - Phone:413-770-3135
Mailing Address - Fax:
Practice Address - Street 1:600 LAUREL ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-3800
Practice Address - Country:US
Practice Address - Phone:413-243-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000000OtherUNKNOWN