Provider Demographics
NPI:1053595496
Name:RICHARD S. DONELA
Entity type:Organization
Organization Name:RICHARD S. DONELA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:DONELA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-523-8345
Mailing Address - Street 1:213 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2510
Mailing Address - Country:US
Mailing Address - Phone:802-442-8448
Mailing Address - Fax:
Practice Address - Street 1:ADIRONDACK MEDICAL CENTER
Practice Address - Street 2:29 CHURCH ST.
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946
Practice Address - Country:US
Practice Address - Phone:518-523-8345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2533213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT25419Medicare UPIN
NYIA0340Medicare PIN