Provider Demographics
NPI:1710994637
Name:MCDONALD, THOMAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
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:PO BOX 11405
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939
Mailing Address - Country:US
Mailing Address - Phone:865-637-6999
Mailing Address - Fax:865-637-6987
Practice Address - Street 1:1630 DOWNTOWN WEST BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-637-6999
Practice Address - Fax:865-637-6987
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017268207VX0201X
IN01077677A207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3020023Medicaid
IN201401610Medicaid
IN201401610Medicaid
IN266180893Medicare PIN
TN3020023Medicaid