MEDICARE: DARIA P MCDONOUGH

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	213E00000X	Podiatrist	P0978	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480014083	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447246947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIA P MCDONOUGH

Provider Business Mailing Address
First Line	:	PO BOX 4211
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32175-4211
Country	:	US
Telephone Number	:	386-672-9932
Fax Number	:	386-672-4201

Provider Business Practice Location Address
First Line	:	284 N HALIFAX DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-5765
Country	:	US
Telephone Number	:	386-672-9932
Fax Number	:	386-672-4201

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	11/14/2014

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Directions to “ DARIA P MCDONOUGH ” Practice Location

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