1497765648 NPI number — DR. DAVID ALEXANDER MACDONALD SR. PH D

Table of content: DR. DAVID ALEXANDER MACDONALD SR. PH D (NPI 1497765648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497765648 NPI number — DR. DAVID ALEXANDER MACDONALD SR. PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONALD
Provider First Name:
DAVID
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PH D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACDONALD
Provider Other First Name:
DAVID
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
SR.
Provider Other Credential Text:
PH D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497765648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
SUITE #4
Provider Business Mailing Address City Name:
STATE COLLEGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-234-4287
Provider Business Mailing Address Fax Number:
814-234-3572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
SUITE #4
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-234-4287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS000107L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06941 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01099501 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: B83028 . This is a "PREFERRED HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0072140090002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 283028 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 51182 . This is a "COVENTRY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4481659 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com