Provider Demographics
NPI:1497765648
Name:MACDONALD, DAVID ALEXANDER SR (PH D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:MACDONALD
Suffix:SR
Gender:M
Credentials:PH D
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:MACDONALD
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:1001 UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-234-4287
Mailing Address - Fax:814-234-3572
Practice Address - Street 1:1001 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE #4
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-234-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000107L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06941OtherVALUE OPTIONS
PA01099501OtherBLUE CROSS
PAB83028OtherPREFERRED HEALTH CARE
PA0072140090002Medicaid
PA283028OtherBLUE SHIELD
KY51182OtherCOVENTRY
PA4481659OtherAETNA
PA283028Medicare ID - Type Unspecified