Provider Demographics
NPI:1588647580
Name:MCDONALD, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2491
Mailing Address - Country:US
Mailing Address - Phone:937-492-2094
Mailing Address - Fax:937-492-1768
Practice Address - Street 1:915 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2491
Practice Address - Country:US
Practice Address - Phone:937-492-2094
Practice Address - Fax:937-492-1768
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072767208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5859537OtherAETNA
OH020040838OtherTRAVLERS RAILROAD
OH000000027728OtherANTHEM
OH2022797Medicaid
OHMC0833071Medicare PIN
OH2022797Medicaid