Provider Demographics
NPI:1003976341
Name:MCDONALD, ANNMARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2916
Mailing Address - Country:US
Mailing Address - Phone:718-704-0953
Mailing Address - Fax:718-228-2601
Practice Address - Street 1:13203 120TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2916
Practice Address - Country:US
Practice Address - Phone:718-704-0953
Practice Address - Fax:718-228-2601
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01947653Medicaid
NYG95653Medicare UPIN
NY0105IEMedicare ID - Type Unspecified