Provider Demographics
NPI:1356447692
Name:MCDONALD, MARY A (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:MCDONALD
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 1:3720 UPTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2224
Mailing Address - Country:US
Mailing Address - Phone:202-966-3720
Mailing Address - Fax:
Practice Address - Street 1:3720 UPTON ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2224
Practice Address - Country:US
Practice Address - Phone:202-966-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038925207Q00000X
MDD74974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS601010OtherFIRSTGUARD
MS34069013OtherBCBS KANSAS CITY
P00152871OtherRAILROAD MEDICARE
MO209351600Medicaid
KS200262200AMedicaid
MS34069013OtherBCBS KANSAS CITY
KS200262200AMedicaid