Provider Demographics
NPI:1255339958
Name:MCDONOUGH, DANIEL G (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:MCDONOUGH
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 1:3007 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5393
Mailing Address - Country:US
Mailing Address - Phone:256-799-2500
Mailing Address - Fax:256-799-2501
Practice Address - Street 1:3007 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5393
Practice Address - Country:US
Practice Address - Phone:256-799-2500
Practice Address - Fax:256-799-2501
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-04-10
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
AL25210174400000X
ALMD252102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051558397Medicaid
AL051558397OtherBCBS
AL331300661Medicaid
AL331334661Medicaid
AL51538378OtherBCBS
AL051558397OtherBCBS
AL051558397Medicaid
ALK325Medicare ID - Type UnspecifiedGROUP