Healthcare Provider Details

I. General information

NPI: 1720325491
Provider Name (Legal Business Name): COREY ALLEN MACDONALD C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PILLSBURY ST SUITE 202
CONCORD NH
03301-3556
US

IV. Provider business mailing address

1 PILLSBURY ST SUITE 202
CONCORD NH
03301-3556
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-4776
  • Fax: 603-228-2113
Mailing address:
  • Phone: 603-224-4776
  • Fax: 603-228-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA123058
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: