Healthcare Provider Details

I. General information

NPI: 1912997156
Provider Name (Legal Business Name): DONALD MILES MACQUEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 DELANEY RD
WILMINGTON NC
28403-6012
US

IV. Provider business mailing address

2321 DELANEY RD
WILMINGTON NC
28403-6012
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-1661
  • Fax: 910-251-8595
Mailing address:
  • Phone: 910-763-1661
  • Fax: 910-251-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number16434
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: