1356787089 NPI number — DR. DONALD RODGERS MCNALLY III D.O.

Table of content: DR. DONALD RODGERS MCNALLY III D.O. (NPI 1356787089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356787089 NPI number — DR. DONALD RODGERS MCNALLY III D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNALLY
Provider First Name:
DONALD
Provider Middle Name:
RODGERS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356787089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 RIVERSIDE ST UNIT 6B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04103-1073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-661-2018
Provider Business Mailing Address Fax Number:
207-661-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SPRINGBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIDDEFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04005-9443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-282-1500
Provider Business Practice Location Address Fax Number:
207-282-2581
Provider Enumeration Date:
05/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0054661 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , with the licence number: 054661 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: DO2802 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)