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NPI Code Detail

MEDICARE: CONAN M MCDONOUGH M.D.

MEDICARE: CONAN M 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
1207L00000XAnesthesiology Physician0101234584VA

General Provider Information

NPI Number : 1932197332
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONAN M MCDONOUGH M.D.
Provider Business Mailing Address
First Line : 5855 BREMO RD
Second Line : SUITE 100 NORTH
City : RICHMOND
State : VA
Zip : 23226-1926
Country : US
Telephone Number : 804-288-6258
Fax Number : 804-282-9921
Provider Business Practice Location Address
First Line : 8260 ATLEE RD
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-1844
Country : US
Telephone Number : 804-288-6258
Fax Number : 804-282-9921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 12/05/2007

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