Provider Demographics
NPI:1134691801
Name:MCDONALD, ELIZABETH FREY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FREY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2250
Mailing Address - Country:US
Mailing Address - Phone:330-714-4935
Mailing Address - Fax:
Practice Address - Street 1:3080 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2250
Practice Address - Country:US
Practice Address - Phone:330-714-4935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000880175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRR737185OtherDRIVERS LICENSE NUMBER