Provider Demographics
NPI:1093881153
Name:MCDONAGH, ANNMARIE S (MD)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:S
Last Name:MCDONAGH
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:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:217-868-2812
Mailing Address - Fax:
Practice Address - Street 1:1005 HEALTH CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4693
Practice Address - Country:US
Practice Address - Phone:217-258-4042
Practice Address - Fax:217-258-4053
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH84062084P0800X
IL036-1467882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry