Provider Demographics
NPI:1861884082
Name:DONAHUE, CHARLES (MSA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 BRADDOCK LN
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3104
Mailing Address - Country:US
Mailing Address - Phone:484-432-2035
Mailing Address - Fax:206-312-9181
Practice Address - Street 1:1457 BRADDOCK LN
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3104
Practice Address - Country:US
Practice Address - Phone:484-432-2035
Practice Address - Fax:206-312-9181
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171WH0202XOther Service ProvidersContractorHome Modifications
No171WV0202XOther Service ProvidersContractorVehicle Modifications