MEDICARE: MR. DOUGLAS P MACDONALD LAC., MAC.

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	225X00000X	Occupational Therapist	1335	NH
2	171100000X	Acupuncturist	25MZ00172500	NJ

General Provider Information

NPI Number	:	1619180270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS P MACDONALD LAC., MAC.

Provider Business Mailing Address
First Line	:	793 GREAT RD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2517
Country	:	US
Telephone Number	:	609-960-4059
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 HARRISTOWN RD STE 304
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-3321
Country	:	US
Telephone Number	:	201-345-6173
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	09/09/2024

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