Provider Demographics
NPI:1619106465
Name:MCALLISTER, DONALD JAMES (SFIDC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W-36 ELLOIT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841
Mailing Address - Country:US
Mailing Address - Phone:401-841-6936
Mailing Address - Fax:401-841-7160
Practice Address - Street 1:2 RESOLUTE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1015
Practice Address - Country:US
Practice Address - Phone:401-841-6936
Practice Address - Fax:401-841-7160
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman