Provider Demographics
NPI:1841304086
Name:MCDONOUGH, JAMES M (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4407
Mailing Address - Country:US
Mailing Address - Phone:828-254-1234
Mailing Address - Fax:828-254-2423
Practice Address - Street 1:5 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4407
Practice Address - Country:US
Practice Address - Phone:828-254-1234
Practice Address - Fax:828-254-2423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20619208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901413Medicaid
NCDR5921OtherMEDICARE RAILROAD
NCC85417Medicare UPIN
NC0751Medicare ID - Type Unspecified