Provider Demographics
NPI:1619167269
Name:MCDONALD, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2840 ELECTRIC RD
Mailing Address - Street 2:SUITE 205A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3551
Mailing Address - Country:US
Mailing Address - Phone:540-904-1388
Mailing Address - Fax:
Practice Address - Street 1:851 THORNBERRY TRL
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-8518
Practice Address - Country:US
Practice Address - Phone:330-549-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4296342085P0229X
NY255838-12085P0229X
OH35.0955112085P0229X
IL0361248612085P0229X
WI54188-202085P0229X
DEC1-00093062085P0229X
KS04-342872085P0229X
SD77212085P0229X
CO485982085P0229X
MO20100091692085P0229X
NE256382085P0229X
NJ25MA083823002085P0229X
TN463822085P0229X
TXN71422085P0229X
KY436362085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169013Medicaid
NJ126567PZEMedicare PIN
NJ167425VA1Medicare UPIN