Individual
DR. MARY B. DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
412 NAMOZINE STREET, BURKEVILLE, VA 23922
(434) 767-5511
Mailing address
2010 ATHERHOLT RD, LYNCHBURG, VA 24501-1106
(434) 200-3656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101032621
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194717744
—
VA
01
—
1580808
CIGNA
VA
01
—
345646
ANTHEM
VA
01
—
4578020
AETNA
VA
05
—
5698529
—
VA
01
—
61459602
BLACK LUNG/FECA
VA
Enumeration date
08/19/2005
Last updated
03/03/2015
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