Provider Demographics
NPI:1487974598
Name:DENIS W. MACDONALD, M.D., P.A.
Entity type:Organization
Organization Name:DENIS W. MACDONALD, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-276-1764
Mailing Address - Street 1:2801 HUDSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4998
Mailing Address - Country:US
Mailing Address - Phone:410-276-1764
Mailing Address - Fax:
Practice Address - Street 1:2801 HUDSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4998
Practice Address - Country:US
Practice Address - Phone:410-276-1764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5550OtherMEDICARE PTAN