Provider Demographics
NPI:1003844937
Name:MCDONNELL, JONELLE K (MD)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:K
Last Name:MCDONNELL
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 1:857 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1170
Mailing Address - Country:US
Mailing Address - Phone:330-923-9585
Mailing Address - Fax:330-923-2290
Practice Address - Street 1:857 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1170
Practice Address - Country:US
Practice Address - Phone:330-923-9585
Practice Address - Fax:330-923-2290
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104122174400000X
OH35058227M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME104122OtherMEDICAL LICENSE FLORIDA
FL145A6OtherBCBS PERSONAL PROVIDER NUMBER
OH2290202Medicaid
FLK6441OtherMEDICARE GROUP NUMBER
FL1376576454OtherGROUP NPI
FL00A58OtherBCBS GROUP PROVIDER NUMBER
FL145A6OtherBCBS PERSONAL PROVIDER NUMBER
FL00A58OtherBCBS GROUP PROVIDER NUMBER
FL1376576454OtherGROUP NPI