Healthcare Provider Details

I. General information

NPI: 1679563530
Provider Name (Legal Business Name): MICHAEL A MCDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INNOVATION DRIVE SUITE 101
SLIPPERY ROCK PA
16057-0000
US

IV. Provider business mailing address

100 INNOVATION DRIVE SUITE 101
SLIPPERY ROCK PA
16057-0000
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-4023
  • Fax: 724-794-3657
Mailing address:
  • Phone: 724-794-4023
  • Fax: 724-794-3657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD046378L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: