Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 7685 | NC |
NPI | 1114941275 |
---|---|
Provider Name | Dr. Patrick M Mcdonough |
First Address | Trent Woods, NC 28562 |
Second Address | Trent Woods, NC 28562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 22/11/2019 |