MEDICARE: DR. ROBERT SEAN MCDONOUGH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	209800000X	Legal Medicine (M.D./D.O.) Physician	MD19250	DC

General Provider Information

NPI Number	:	1033325881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SEAN MCDONOUGH M.D.

Provider Business Mailing Address
First Line	:	151 FARMINGTON AVE
Second Line	:	AETNA, AEB6
City	:	HARTFORD
State	:	CT
Zip	:	06156-0001
Country	:	US
Telephone Number	:	860-273-4860
Fax Number	:	860-262-9466

Provider Business Practice Location Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:	PMB 106-204
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:	860-273-0123
Fax Number	:	860-262-9466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	10/15/2011

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