Healthcare Provider Details

I. General information

NPI: 1992062665
Provider Name (Legal Business Name): VIRGINIA LOCKE MACDONALD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WASHINGTON RD
RYE NH
03870-2456
US

IV. Provider business mailing address

112 WASHINGTON RD
RYE NH
03870-2456
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-9278
  • Fax:
Mailing address:
  • Phone: 603-436-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: