Provider Demographics
NPI:1821423070
Name:GENEVIEVE A. MACDONALD, M.D., INC.
Entity Type:Organization
Organization Name:GENEVIEVE A. MACDONALD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-0595
Mailing Address - Street 1:16200 VENTURA BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2205
Mailing Address - Country:US
Mailing Address - Phone:818-990-0595
Mailing Address - Fax:818-990-0553
Practice Address - Street 1:16200 VENTURA BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2205
Practice Address - Country:US
Practice Address - Phone:818-990-0595
Practice Address - Fax:818-990-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16852208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty