Provider Demographics
NPI:1366604555
Name:DONOHUE, KEVIN JONATHAN (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JONATHAN
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:571-634-3636
Mailing Address - Fax:703-237-7959
Practice Address - Street 1:200 PARK AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:571-634-3636
Practice Address - Fax:703-237-7959
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204868207R00000X
PAOT012719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine