Provider Demographics
NPI:1093385353
Name:MCDONALD, CORISSA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CORISSA
Middle Name:NICOLE
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:FAMILY MEDICINE CENTER
Mailing Address - Street 2:40 MEDICAL PARK SUITE 401
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-3880
Mailing Address - Fax:304-243-3895
Practice Address - Street 1:FAMILY MEDICINE CENTER
Practice Address - Street 2:40 MEDICAL PARK SUITE 401
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3880
Practice Address - Fax:304-243-3895
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program