1912441262 NPI number — THOMAS MCDONALD

Table of content: THOMAS MCDONALD (NPI 1912441262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912441262 NPI number — THOMAS MCDONALD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912441262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 952
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNSTABLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02630-0952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-989-1416
Provider Business Mailing Address Fax Number:
802-244-4334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 BOW LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNSTABLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02630-0952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-989-1416
Provider Business Practice Location Address Fax Number:
802-244-4334
Provider Enumeration Date:
12/06/2016

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: 183500000X , with the licence number:  PH22588 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PCT.0006887 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 033.0003431 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 033.0003431 . This is a "VERMONT BOARD OF PHARMACY IDENTIFICATION" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: CPN202-0014 . This is a "APHA IMMUNIZATION CERTIFICATION (ALBANY COLLEGE OF PHARMACY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PCT.0006887 . This is a "CONNECTICUT BOARD OF PHARMACY REGISTRATION ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PH22588 . This is a "MASSACHUSETTS BOARD OF PHARMACY REGISTRATION ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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