Provider Demographics
NPI:1568402675
Name:MCDONALD, MARYANNE BEATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:BEATRICE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9040 REID ST
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-4185
Mailing Address - Fax:253-968-1188
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-4185
Practice Address - Fax:253-968-1188
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-04-24
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Provider Licenses
StateLicense IDTaxonomies
WAMD00020851207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA154293OtherL & I PROVIDER NUMBER
WA1114446Medicaid
WA1114446Medicaid