Provider Demographics
NPI:1598881419
Name:MACDONALD, JOHN DAVID (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MEDICAL ASSISTANT
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 594
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-0594
Mailing Address - Country:US
Mailing Address - Phone:802-674-1812
Mailing Address - Fax:
Practice Address - Street 1:5 ROPE FERRY RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1404
Practice Address - Country:US
Practice Address - Phone:603-646-9400
Practice Address - Fax:603-646-9450
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program