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General NPI Number Information
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NPI Number | 1790379204
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Entity Type | Individual
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Provider Name | MICHAEL J MCDONALD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 705 BATTLEFIELD BLVD N
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4901
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Country | US
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Telephone | 757-547-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 5102 WHITEHALL DR
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City | CLIFTON HEIGHTS
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State | PA
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Zip | 19018-1219
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Country | US
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Telephone | 215-680-5111
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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 | 0101275839
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0102207477
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License Number State | VA
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