Healthcare Provider Details

I. General information

NPI: 1306540596
Provider Name (Legal Business Name): JACOB MACDONALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN STREET
CINCINNATI OH
45219-0796
US

IV. Provider business mailing address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-6098
  • Fax: 513-558-7137
Mailing address:
  • Phone: 513-558-6098
  • Fax: 513-558-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35.152070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: