Provider Demographics
NPI:1104832054
Name:MACDONALD, BRIAN DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:81 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2690
Mailing Address - Country:US
Mailing Address - Phone:207-725-4008
Mailing Address - Fax:207-725-5749
Practice Address - Street 1:81 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2100
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2690
Practice Address - Country:US
Practice Address - Phone:207-725-4008
Practice Address - Fax:207-725-5749
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD 1070213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433983899Medicaid
ME0915250001Medicare NSC
U85561Medicare UPIN