Healthcare Provider Details

I. General information

NPI: 1427187152
Provider Name (Legal Business Name): RUSSELL DAVID MACDONALD MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ORNGE TRANSPORT MEDICINE 20 CARLSON COURT, SUITE 400
TORONTO ONTARIO
M9W 7K6
CA

IV. Provider business mailing address

14375 8TH CONCESSION RR #1
SCHOMBERG ONTARIO
L0G1T0
CA

V. Phone/Fax

Practice location:
  • Phone: 647-428-2034
  • Fax: 647-428-2006
Mailing address:
  • Phone: 905-859-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number154068
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: