Provider Demographics
NPI:1053336420
Name:DONAHUE-LUNSFORD, KEITINA (DO)
Entity type:Individual
Prefix:
First Name:KEITINA
Middle Name:
Last Name:DONAHUE-LUNSFORD
Suffix:
Gender:F
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:RR 1 BOX 37
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-9705
Mailing Address - Country:US
Mailing Address - Phone:304-743-9646
Mailing Address - Fax:
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9202
Practice Address - Country:US
Practice Address - Phone:304-757-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010286207P00000X
OH58.001256207P00000X
WV1970207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000900Medicaid
WV001858267OtherBC/BS
WV1066227OtherDWC
WV3810000900Medicaid
WVP00392234Medicare PIN
WV3810000900Medicaid