Provider Demographics
NPI:1346810330
Name:MACDONALD, MATTHEW JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:MACDONALD
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 1:4539 CAMBIE STREET
Mailing Address - Street 2:UNIT 104
Mailing Address - City:VANCOUVER
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V5Z2Y9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4539 CAMBIE STREET
Practice Address - Street 2:UNIT 104
Practice Address - City:VANCOUVER
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V5Z2Y9
Practice Address - Country:CA
Practice Address - Phone:604-341-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
41280OtherCPSID, (BC, CANADA)