Provider Demographics
NPI:1487833901
Name:ROBERT M. MCDONALD, MD PA
Entity type:Organization
Organization Name:ROBERT M. MCDONALD, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-770-4550
Mailing Address - Street 1:30 E DOVER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3048
Mailing Address - Country:US
Mailing Address - Phone:470-770-4550
Mailing Address - Fax:410-770-4552
Practice Address - Street 1:30 E DOVER ST
Practice Address - Street 2:SUITE C
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3048
Practice Address - Country:US
Practice Address - Phone:470-770-4550
Practice Address - Fax:410-770-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0009024173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD849LMedicare PIN
MDD70258Medicare UPIN