MEDICARE: DOUGLAS JESSE MACKAY N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	37	NH

General Provider Information

NPI Number	:	1124463237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS JESSE MACKAY N.D.

Provider Business Mailing Address
First Line	:	1828 L ST NW
Second Line	:	STE 510
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5104
Country	:	US
Telephone Number	:	603-969-4470
Fax Number	:	202-204-7701

Provider Business Practice Location Address
First Line	:	1828 L ST NW
Second Line	:	STE 510
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5104
Country	:	US
Telephone Number	:	603-969-4470
Fax Number	:	202-204-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/02/2013

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