Provider Demographics
NPI:1659323186
Name:O'DONNELL, MEGHAN (MD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:O'DONNELL
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 1:1501 S YALE ST
Mailing Address - Street 2:BUILDING 2, SUITE 150
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7304
Mailing Address - Country:US
Mailing Address - Phone:928-527-4325
Mailing Address - Fax:928-527-4327
Practice Address - Street 1:1501 S YALE ST
Practice Address - Street 2:BUILDING 2, SUITE 150
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7304
Practice Address - Country:US
Practice Address - Phone:928-527-4325
Practice Address - Fax:928-527-4327
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94611207Q00000X
AZ40649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine