Provider Demographics
NPI:1912968025
Name:MCDONNELL, ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:MCDONNELL
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 1:15916 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1954
Mailing Address - Country:US
Mailing Address - Phone:718-275-1010
Mailing Address - Fax:
Practice Address - Street 1:15916 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1954
Practice Address - Country:US
Practice Address - Phone:718-275-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-22142085R0202X
OH35.0838692085R0202X
PAMD4203262085R0202X
NY1707642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP003722227OtherRAILROAD MC
NY01318092Medicaid
WV3810007239Medicaid
OH2759671Medicaid
OHP00359299OtherRAILROAD MC
NY01318092Medicaid
NYRA2869Medicare PIN
OHP00359299OtherRAILROAD MC
WV3810007239Medicaid