Provider Demographics
NPI:1780833996
Name:MACDONALD, MATTHEW SCOT (AUD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOT
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2561 LAC DE VILLE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5645
Mailing Address - Country:US
Mailing Address - Phone:585-461-9192
Mailing Address - Fax:585-461-9196
Practice Address - Street 1:2561 LAC DE VILLE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5645
Practice Address - Country:US
Practice Address - Phone:585-461-9192
Practice Address - Fax:585-461-9196
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000009439237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17571AMedicare PIN