Provider Demographics
NPI:1285661991
Name:MCDONALD, COLIN TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:TIMOTHY
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 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-7224
Mailing Address - Fax:336-718-7598
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7224
Practice Address - Fax:336-718-7598
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV309132084N0400X
ME0187362084N0400X
NC2009-011562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435937199Medicaid
MA9734643Medicaid
MA9734643Medicaid
ME435937199Medicaid
MAM13178Medicare ID - Type Unspecified
MEA2269201Medicare PIN