Provider Demographics
NPI:1235544073
Name:MCDONALD, MATTHEW J (PA-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:91 MONTVALE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3623
Mailing Address - Country:US
Mailing Address - Phone:781-835-2111
Mailing Address - Fax:781-438-5588
Practice Address - Street 1:91 MONTVALE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3623
Practice Address - Country:US
Practice Address - Phone:781-835-2111
Practice Address - Fax:781-438-5588
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4442363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical