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NPI Code Detail

MEDICARE: MARK MCDONALD

MEDICARE: MARK MCDONALD
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
1225100000XPhysical Therapist037295NY

General Provider Information

NPI Number : 1861818494
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK MCDONALD
Provider Business Mailing Address
First Line : 16 MAYBROOK RD
Second Line : SUITE A
City : CAMPBELL HALL
State : NY
Zip : 10916-2743
Country : US
Telephone Number : 845-636-4344
Fax Number :
Provider Business Practice Location Address
First Line : 1450 ROUTE 208
Second Line :
City : WALLKILL
State : NY
Zip : 12589-3799
Country : US
Telephone Number : 845-895-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2014
Last Update Date : 03/06/2014

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