Provider Demographics
NPI:1780026641
Name:MCDONALD, ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SYLVAN RD STE 750
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1852
Mailing Address - Country:US
Mailing Address - Phone:781-937-3001
Mailing Address - Fax:781-937-3070
Practice Address - Street 1:100 TRADECENTER
Practice Address - Street 2:SUITE 750
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1851
Practice Address - Country:US
Practice Address - Phone:781-937-3001
Practice Address - Fax:781-937-3070
Is Sole Proprietor?:No
Enumeration Date:2013-07-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant