Provider Demographics
NPI:1811989288
Name:MCDANNOLD, TERRY A (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:MCDANNOLD
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-341-7482
Practice Address - Street 1:2900 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5427
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-363-2140
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023042174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
310674100OtherUS DEPT OF LABOR
0633858OtherAETNA
0420592OtherUNITED HEALTHCARE
50006695OtherPASSPORT
KY64230428Medicaid
000000175984OtherANTHEM
021036000OtherFEDERAL BLACK LUNG
OH0584274Medicaid
50010291OtherPASSPORT
IN200916600Medicaid
A82688Medicare UPIN
IN200916600Medicaid
310674100OtherUS DEPT OF LABOR
50010291OtherPASSPORT
KY0399014Medicare PIN
KY3313250Medicare PIN
021036000OtherFEDERAL BLACK LUNG
0633858OtherAETNA