Individual
DEREK DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
27 WILLIAM F PALMER RD, MOODUS, CT 06469-1132
(860) 873-1414
(860) 358-8659
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-05911
NC
363A00000X
Physician Assistant
Primary
003652
CT
Other
Enumeration date
09/01/2015
Last updated
04/12/2017
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