Healthcare Provider Details

I. General information

NPI: 1114920576
Provider Name (Legal Business Name): GREGG C DONALDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SETON DR
CUMBERLAND MD
21502-1818
US

IV. Provider business mailing address

912 SETON DR
CUMBERLAND MD
21502-1818
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-3111
  • Fax: 301-722-5135
Mailing address:
  • Phone: 301-722-3111
  • Fax: 301-722-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0042054
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: