=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942592514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD MCDONALD D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2011
-----------------------------------------------------
Last Update Date | 05/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 281 MAIN ST
-----------------------------------------------------
City | EAST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-569-5900
-----------------------------------------------------
Fax | 860-310-2127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 BIRNIE AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01107-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-243-4357
-----------------------------------------------------
Fax | 413-451-0037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 053445
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 53445
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1026351
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------