Provider Demographics
NPI:1639304843
Name:ELLEN MCDONALD, M.D., INC.
Entity Type:Organization
Organization Name:ELLEN MCDONALD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-872-4195
Mailing Address - Street 1:800 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3150
Mailing Address - Country:US
Mailing Address - Phone:626-872-4195
Mailing Address - Fax:626-628-1836
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-872-4195
Practice Address - Fax:626-628-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty