Individual
PETER C. DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 773-8161
(207) 773-1489
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-666
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273630099
—
ME
Enumeration date
09/20/2006
Last updated
08/03/2012
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