Healthcare Provider Details

I. General information

NPI: 1568309169
Provider Name (Legal Business Name): DONALD MACELROY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

265 BOWEN ST APT 2
PROVIDENCE RI
02906-2250
US

V. Phone/Fax

Practice location:
  • Phone: 518-424-4631
  • Fax:
Mailing address:
  • Phone: 401-793-2695
  • Fax: 401-444-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: