Provider Demographics
NPI:1114980547
Name:MCNAUGHTON, DAWN P (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:P
Last Name:MCNAUGHTON
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 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-0255
Practice Address - Street 1:1140 S KNOXVILLE AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2609
Practice Address - Country:US
Practice Address - Phone:419-394-9959
Practice Address - Fax:419-394-0255
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078632M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003049OtherMEDICAID LEGACY
OH2658137Medicaid
OH9934723OtherMEDICARE ORGANIZATIONAL PTAN
OH1689619199OtherORGANIZATIONAL NPI
OHMC4232401Medicare PIN