Mark E Donnelly, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

18917 Issued in AZ

Practice address

1215 N Beaver St
Ste 202
Flagstaff, AZ 86001-3126

Phone

(928) 773-2200

Fax

(928) 773-2201

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  NPD (past)
• Northern Arizona Surgical

  • Surgery Physician
  • Flagstaff, AZ
  • NPI 1194809699
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489449600000",
    "number": "1902802192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "address_2": "PAYER CREDENTIALING",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-773-2559",
            "fax_number": "928-213-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N BEAVER ST",
            "address_2": "STE 202",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013126",
            "telephone_number": "928-773-2200",
            "fax_number": "928-773-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2017-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "18917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286874",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01112889",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cathron Donaldson, PT
• Donna Jean Donaldson, AU.D.
• Janis Doneski-Nicol, M.S., CCC-SLP, ATP
• Kira Donnelly, PT
• Margaret Hildebrand Donnelly, MD
• Michael Terence Donohue, PT
• Shannon Dooley
• Sherry Dooley, CCC-SLP
• Melanie Dorn, PHARMD
• Justin Daniel Doroshenko, DO

• Specialist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.