Provider Demographics
NPI:1194925644
Name:MCDONOUGH, CHRISTIAN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:PAUL
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 MAYWOOD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1906
Mailing Address - Country:US
Mailing Address - Phone:201-546-1374
Mailing Address - Fax:
Practice Address - Street 1:351 MAYWOOD AVE FL 2
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1906
Practice Address - Country:US
Practice Address - Phone:201-546-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08741600207L00000X
NY240836275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0236934Medicaid
NJP00953296OtherRR MCR PTAN
NJP00953296OtherRR MCR PTAN
NJ189294A01Medicare PIN