Provider Demographics
NPI:1487615589
Name:MACDONALD, SUSAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN MARIE
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 ANGEL'S ROAD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:NF
Mailing Address - Zip Code:A1L2C8
Mailing Address - Country:CA
Mailing Address - Phone:709-777-7436
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL CANCER TREATMENT
Practice Address - Street 2:300 PRINCE PHILIP DR/ST. JOHNS
Practice Address - City:ST. JOHN'S
Practice Address - State:NF
Practice Address - Zip Code:A1B3V6
Practice Address - Country:CA
Practice Address - Phone:709-777-7436
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1547172084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine