Basic Information
| Provider Information | |||||||||
| NPI: | 1154558476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONNELL | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HENNESY | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4755 OGLETOWN STANTON ROAD | ||||||||
| Address2: | CHRISTIANA HOSPITAL, SUITE 5A43 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026230188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON ROAD | ||||||||
| Address2: | SUITE 5A43 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026230188 | ||||||||
| FaxNumber: | 6029330755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 08/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C1-0011776 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 47714 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 47714 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 47714 | AZ | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 813315 | 05 | AZ | MEDICAID |