Provider Demographics
NPI:1710989322
Name:DONEGAN, SAMUEL P (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:P
Last Name:DONEGAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BALTIMORE
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 OAK STREET
Practice Address - Street 2:SUITE 223E
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-427-2222
Practice Address - Fax:508-897-4773
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0068818207V00000X
MA56194207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152599ZEZTOtherMEDICARE PTAN
MD022452900Medicaid
MD165767OtherMEDICARE GROUP PTAN
MA110043227AMedicaid
MD950201OtherCAREFIRST RENDERING NUMBER
Q818-0019OtherCAREFIRST