Provider Demographics
NPI:1871522763
Name:DONALDSON, JAMES KENNETH (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:DONALDSON
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 1:443 SHORE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2642
Mailing Address - Country:US
Mailing Address - Phone:609-569-7077
Mailing Address - Fax:
Practice Address - Street 1:443 SHORE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2642
Practice Address - Country:US
Practice Address - Phone:609-569-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06695700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ30028371OtherKEYSTONE
NJ8483809Medicaid
NJ2080189000OtherAMERIHEALTH
NJ60018851OtherHORIZON NJ HEALTH
NJ30028371OtherKEYSTONE
NJ8483809Medicaid
NJ046733UKEMedicare PIN