Healthcare Provider Details

I. General information

NPI: 1790742849
Provider Name (Legal Business Name): JOHN MCDONOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 DELAWARE AVE
MARION OH
43302-6416
US

IV. Provider business mailing address

# L-3652
COLUMBUS OH
43260-6052
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7950
  • Fax: 740-383-7097
Mailing address:
  • Phone: 740-383-7927
  • Fax: 740-383-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35081423M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: