Healthcare Provider Details

I. General information

NPI: 1124597588
Provider Name (Legal Business Name): MICHAEL PATRICK MACDONALD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BUMPS POND ROAD
PLYMOUTH MA
02360
US

IV. Provider business mailing address

11 GIBBENS ST
WEYMOUTH MA
02188-2608
US

V. Phone/Fax

Practice location:
  • Phone: 508-291-2441
  • Fax:
Mailing address:
  • Phone: 781-858-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2312494
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: