Healthcare Provider Details

I. General information

NPI: 1992258289
Provider Name (Legal Business Name): RODERICK MARSHALL MACDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF WASHINGTON MC 1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1735 24TH AVE UNIT B
SEATTLE WA
98122-3091
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3300
  • Fax:
Mailing address:
  • Phone: 413-285-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.60955271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: