Healthcare Provider Details

I. General information

NPI: 1467495929
Provider Name (Legal Business Name): JOSEPH C MACDONALD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HIGHLANDS DR
LITITZ PA
17543-7694
US

IV. Provider business mailing address

409 SOUTH SECOND STREET SUITE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8772
  • Fax: 717-231-8435
Mailing address:
  • Phone: 717-231-8772
  • Fax: 717-231-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS010453L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101043892
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: