Provider Demographics
NPI:1255586855
Name:THOMAS A. DONOHUE, MD, PLLC
Entity type:Organization
Organization Name:THOMAS A. DONOHUE, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-737-0395
Mailing Address - Street 1:119 WEDDINGTON BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3204
Mailing Address - Country:US
Mailing Address - Phone:606-432-8008
Mailing Address - Fax:606-432-8011
Practice Address - Street 1:119 WEDDINGTON BRANCH RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3204
Practice Address - Country:US
Practice Address - Phone:606-432-8008
Practice Address - Fax:606-432-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20898208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00802010OtherMEDICARE PIN FOR INDIVIDUAL NPI 1427082940
KY64208986Medicaid
KY00802OtherMEDICARE PTAN NUMBER FOR NPI 1255586855
WV3810015629OtherWEST VIRGINIA MEDICAID FOR NPI # 1255586855