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General NPI Number Information
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NPI Number | 1639304843
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Entity Type | Organization
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Legal Business Name | ELLEN MCDONALD, M.D., INC.
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 800 FAIRMOUNT AVE SUITE 210
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City | PASADENA
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State | CA
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Zip | 91105-3150
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Country | US
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Telephone | 626-872-4195
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Fax | 626-628-1836
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Provider Business Mailing Address
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Address Line | 800 FAIRMOUNT AVE SUITE 210
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City | PASADENA
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State | CA
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Zip | 91105-3150
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Country | US
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Telephone | 626-872-4195
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Fax | 626-628-1836
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLEN KATHLEEN MCDONALD
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Credential | M.D.
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Telephone | 626-872-4195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A102543
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License Number State | CA
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