Provider Demographics
NPI:1114960127
Name:MCDANNOLD, PEGGY (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MCDANNOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:JAEGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:525 ALEXANDRIA PIKE
Mailing Address - Street 2:STE 300
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-3290
Mailing Address - Country:US
Mailing Address - Phone:859-781-2210
Mailing Address - Fax:859-781-0289
Practice Address - Street 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071-3290
Practice Address - Country:US
Practice Address - Phone:859-781-2210
Practice Address - Fax:859-781-0289
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY110206742OtherRAILROAD MEDICARE
KY64275274Medicaid
OH0599115Medicaid
KY64275274Medicaid
OH0599115Medicaid
KY0387532Medicare PIN