Provider Demographics
NPI:1730143603
Name:MCDONALD, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1140 QUINCY AVE.
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1038
Mailing Address - Country:US
Mailing Address - Phone:570-983-0360
Mailing Address - Fax:570-983-0375
Practice Address - Street 1:1140 QUINCY AVE.
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18510-1038
Practice Address - Country:US
Practice Address - Phone:570-983-0360
Practice Address - Fax:570-983-0375
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037160E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011921920002Medicaid
PA012378500OtherFED BLACK LUNG
PAE12944Medicare UPIN
PA0011921920002Medicaid