Healthcare Provider Details

I. General information

NPI: 1982695383
Provider Name (Legal Business Name): WILLIAM L MCDONALD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 04/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 DILEY RD STE 200
CANAL WINCHESTER OH
43110-9612
US

IV. Provider business mailing address

7901 DILEY RD STE 200
CANAL WINCHESTER OH
43110-9612
US

V. Phone/Fax

Practice location:
  • Phone: 614-835-3838
  • Fax: 614-834-4750
Mailing address:
  • Phone: 614-835-3838
  • Fax: 614-834-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number224364
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-007196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: