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General NPI Number Information
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NPI Number | 1104858869
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Entity Type | Individual
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Provider Name | CHRISTOPHER MACDONALD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 401 W SPRING ST SUITE 2D, PENNWOOD CENTER
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City | TITUSVILLE
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State | PA
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Zip | 16354-2169
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Country | US
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Telephone | 814-824-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SHENANGO AVE P.O. BOX 716
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City | SHARON
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State | PA
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Zip | 16146-1503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS-010946-L
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License Number State | PA
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