Healthcare Provider Details

I. General information

NPI: 1982757837
Provider Name (Legal Business Name): BRIAN MCDONALD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 PAOLI PIKE
MALVERN PA
19355-3311
US

IV. Provider business mailing address

414 PAOLI PIKE
MALVERN PA
19355-3311
US

V. Phone/Fax

Practice location:
  • Phone: 484-596-3943
  • Fax: 484-296-4915
Mailing address:
  • Phone: 484-596-3943
  • Fax: 484-296-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number229614
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MB08719300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS15823
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: