Provider Demographics
NPI:1114212859
Name:MCDONALD, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:MCDONALD
Suffix:
Gender:M
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:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:STE 420
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5741
Practice Address - Country:US
Practice Address - Phone:843-723-3441
Practice Address - Fax:843-805-4040
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN16014207R00000X
SC37812207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine