Provider Demographics
NPI:1972618775
Name:MCDONALD, ANDREW TAD (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TAD
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3005
Mailing Address - Fax:812-242-3054
Practice Address - Street 1:1725 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4010
Practice Address - Country:US
Practice Address - Phone:812-242-3005
Practice Address - Fax:812-242-3054
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36113741207QS0010X
IN01062210A2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200826590Medicaid
INN357972Medicaid
7037789OtherAETNA
INP00866719OtherRAILROAD MEDICARE
000000481762OtherANTHEM
IN351904269250Medicaid
351904269EOtherSAGAMORE
5055772OtherCIGNA
P00360017OtherRAILROAD MEDICARE PALAMET
INP00866719OtherRAILROAD MEDICARE
351904269EOtherSAGAMORE
5055772OtherCIGNA
INN357972Medicaid