Provider Demographics
NPI:1477512077
Name:MCDONALD, GEORGE V (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:V
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 1:200 SOMERSET ST
Mailing Address - Street 2:MILLINOCKET UROLOGY
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1258
Mailing Address - Country:US
Mailing Address - Phone:207-723-5161
Mailing Address - Fax:207-723-3029
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:MILLINOCKET UROLOGY
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1258
Practice Address - Country:US
Practice Address - Phone:207-723-5161
Practice Address - Fax:207-723-3029
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME005867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022328OtherANTHEM
5862648OtherAETNA US HEALTHCARE
MI200003Medicare ID - Type Unspecified
D79245Medicare UPIN
ME022328OtherANTHEM