Provider Demographics
NPI:1093057630
Name:CARDONELL, MAGGIE A (MD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:A
Last Name:CARDONELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:A
Other - Last Name:FEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3215 WINGATE COURT, STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7214
Practice Address - Country:US
Practice Address - Phone:573-882-8920
Practice Address - Fax:573-884-4868
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018008043207WX0110X, 207W00000X
OH130882207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist