Individual
KEVIN DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
430 ALTAIR PKWY, STE 210, WESTERVILLE, OH 43082-4647
(614) 898-7546
(614) 794-4294
Mailing address
430 ALTAIR PKWY, STE 210, WESTERVILLE, OH 43082-4647
(614) 898-7546
(614) 794-4294
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35139165
OH
207R00000X
Internal Medicine Physician
57.028833
OH
390200000X
Student in an Organized Health Care Education/Training Program
RS2020-0028
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001380472
ANTHEM
OH
Enumeration date
04/04/2016
Last updated
04/30/2021
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