Provider Demographics
NPI:1861697625
Name:DATLOW, DONALD WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILLIAM
Last Name:DATLOW
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 1:4515 WILLARD AVE
Mailing Address - Street 2:APT S1015
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3622
Mailing Address - Country:US
Mailing Address - Phone:301-652-0215
Mailing Address - Fax:
Practice Address - Street 1:4515 WILLARD AVE
Practice Address - Street 2:APT S1015
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3622
Practice Address - Country:US
Practice Address - Phone:301-652-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0000977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MHE63703Medicare UPIN