Individual
SEAN M MCDONOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8100 INNOVATION PARK DR # 110, FAIRFAX, VA 22031-4870
(703) 970-6464
(571) 414-6941
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007777
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/04/2020
Last updated
04/20/2021
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