Provider Demographics
NPI:1225086994
Name:MACDONNELL, WILLIAM E (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:MACDONNELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3500 BOSTON ST STE J1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5723
Mailing Address - Country:US
Mailing Address - Phone:410-522-0001
Mailing Address - Fax:410-522-0017
Practice Address - Street 1:1501 W MOUNT ROYAL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4289
Practice Address - Country:US
Practice Address - Phone:410-225-4118
Practice Address - Fax:410-225-0252
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP45001Medicare UPIN
MDH822K788Medicare ID - Type Unspecified