Provider Demographics
NPI:1841373362
Name:MACDONALD, MARY CAREY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CAREY
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72098
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:419-281-0451
Mailing Address - Fax:419-281-9339
Practice Address - Street 1:2212 MIFFLIN AVE STE 220
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8846
Practice Address - Country:US
Practice Address - Phone:419-281-0451
Practice Address - Fax:419-207-2641
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350749208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149455Medicaid
OH2149455Medicaid