Provider Demographics
NPI:1780759027
Name:ALBERTSON, DONAVON R (MD)
Entity type:Individual
Prefix:
First Name:DONAVON
Middle Name:R
Last Name:ALBERTSON
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 1:333 BORTHWICK AVE
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-433-4012
Mailing Address - Fax:603-433-5184
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-4012
Practice Address - Fax:603-433-5184
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6323207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0104696Y0NH01OtherANTHEM
ME332350099Medicaid
930050642OtherRAILROAD MEDICARE
MA0194816Medicaid
NH30009961Medicaid
NH30009961Medicaid
NH0104696Y0NH01OtherANTHEM
NHNH0154Medicare ID - Type Unspecified