Healthcare Provider Details

I. General information

NPI: 1992372601
Provider Name (Legal Business Name): CHLOE MARISE MCDONAGH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 8TH AVE SE STE 300
CEDAR RAPIDS IA
52401-2106
US

IV. Provider business mailing address

15496 ABBEY CIR
PEOSTA IA
52068-9678
US

V. Phone/Fax

Practice location:
  • Phone: 563-590-5270
  • Fax:
Mailing address:
  • Phone: 563-590-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number107446
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: