Provider Demographics
NPI:1720287162
Name:MCDONALD, DONNA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
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 1:1960 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1363
Mailing Address - Country:US
Mailing Address - Phone:740-344-8687
Mailing Address - Fax:740-522-5110
Practice Address - Street 1:1960 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1363
Practice Address - Country:US
Practice Address - Phone:740-344-8687
Practice Address - Fax:740-522-5110
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052307208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0614973Medicaid