Paul Thomas Donnelly, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

162852-1 Issued in NY

Practice address

104 S Porter St
Watkins Glen, NY 14891-1622

Phone

(607) 535-7873

Fax

(607) 535-7469

NPI assigned

Jun 29, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chemung Medical Services PC

  • Internal Medicine Physician
  • Elmira, NY
  • NPI 1356378889

  Family Medicine

  NPD (past)
• Fort Edward Rescue Squad Inc

  • Ambulance
  • Fort Edward, NY
  • NPI 1427031319
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1386672368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S PORTER ST",
            "city": "WATKINS GLEN",
            "state": "NY",
            "postal_code": "148911622",
            "telephone_number": "607-535-7873",
            "fax_number": "607-535-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "PAUL",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "162852-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080194958",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01037172",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mihai Dascalu, M.D.
• Cori Delgrosso, RPN
• Melissa L Depaolo, LCSW
• Sara Diehr, PT, DPT
• Kelly L Dietz
• Marcia N Douglas, LCSW R
• Wendy Drake
• Ester Edelman, LMSW
• Fazzary Eye Care, LLC
• Kevin Stewart Field, PH.D.

• Family Medicine Physician in Watkins Glen, NY
• Providers in Watkins Glen, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.