Healthcare Provider Details

I. General information

NPI: 1902434830
Provider Name (Legal Business Name): DEIRDRE CATHERINA MCDONNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8016
US

IV. Provider business mailing address

1101 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8016
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-7246
  • Fax: 270-554-8987
Mailing address:
  • Phone: 812-477-7246
  • Fax: 270-554-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12160
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01091149A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number58408
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01091149A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: