Provider Demographics
NPI:1306004544
Name:MCDONALD, MATTHEW BASIL III (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BASIL
Last Name:MCDONALD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:379 CAMPUS DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1161
Mailing Address - Country:US
Mailing Address - Phone:732-507-6545
Mailing Address - Fax:908-389-5675
Practice Address - Street 1:3575 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1271
Practice Address - Country:US
Practice Address - Phone:609-631-2800
Practice Address - Fax:609-631-2896
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT188382282NC2000X
NJ25MA09461100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No282NC2000XHospitalsGeneral Acute Care HospitalChildren