Provider Demographics
NPI:1164427985
Name:MCDONALD, MARY N (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
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:PO BOX 1798
Mailing Address - Street 2:DEPT 95
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-9715
Mailing Address - Country:US
Mailing Address - Phone:901-752-4500
Mailing Address - Fax:901-752-4328
Practice Address - Street 1:7205 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1758
Practice Address - Country:US
Practice Address - Phone:901-752-4500
Practice Address - Fax:901-752-4328
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-12-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-27
Provider Licenses
StateLicense IDTaxonomies
TN15781207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160033801OtherRAILROAD MEDICARE
4032437OtherAETNA
TN71967OtherBCBS
2568013OtherCIGNA
4032437OtherAETNA
4032437OtherAETNA
MS$$$$$$$$$OtherBCBS
TN309723Medicare PIN