MEDICARE: THOMAS JOSEPH MCDONALD JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	9500144	NC
2	207VX0000X	Obstetrics Physician	9500144	NC
3	207V00000X	Obstetrics & Gynecology Physician	9500144	NC

General Provider Information

NPI Number	:	1053319327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOSEPH MCDONALD JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 YADKIN ST
Second Line	:	STE 102
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-3449
Country	:	US
Telephone Number	:	980-323-5330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/15/2024

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