Provider Demographics
NPI:1700209830
Name:MEDICAL ASSOCIATE SERVICES, P.C.
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATE SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:408-364-6160
Mailing Address - Street 1:2050 MERCANTILE DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4053
Mailing Address - Country:US
Mailing Address - Phone:910-371-2500
Mailing Address - Fax:
Practice Address - Street 1:2050 MERCANTILE DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4053
Practice Address - Country:US
Practice Address - Phone:910-371-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit