Individual
JOHN MCDONOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1040 DELAWARE AVE, MARION, OH 43302-6416
(740) 383-7950
(740) 383-7097
Mailing address
# L-3652, COLUMBUS, OH 43260-6052
(740) 383-7927
(740) 383-7942
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35081423M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000233026
ANTHEM
OH
01
—
020052624
TRAVELERS MEDICARE
—
01
—
1402423
UHC
—
05
—
2333853
—
OH
01
—
311098079
TAX ID
—
01
—
353077
SUBMITTER NO
—
01
—
7794409
AETNA
—
Enumeration date
05/01/2006
Last updated
12/15/2021
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