Healthcare Provider Details

I. General information

NPI: 1124463237
Provider Name (Legal Business Name): DOUGLAS JESSE MACKAY N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 L ST NW STE 510
WASHINGTON DC
20036-5104
US

IV. Provider business mailing address

1828 L ST NW STE 510
WASHINGTON DC
20036-5104
US

V. Phone/Fax

Practice location:
  • Phone: 603-969-4470
  • Fax: 202-204-7701
Mailing address:
  • Phone: 603-969-4470
  • Fax: 202-204-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number37
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: