Provider Demographics
NPI:1871998179
Name:DONOHOE, ANDREA J (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:DONOHOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 REGENCY PL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3269
Mailing Address - Country:US
Mailing Address - Phone:301-645-3420
Mailing Address - Fax:
Practice Address - Street 1:4475 REGENCY PL
Practice Address - Street 2:SUITE 303
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20602-3269
Practice Address - Country:US
Practice Address - Phone:301-645-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004785363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1122710OtherNCCPA