Provider Demographics
NPI:1891862520
Name:MACPHERSON, DOUGLAS N (LIC AC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:N
Last Name:MACPHERSON
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4353
Mailing Address - Country:US
Mailing Address - Phone:617-876-3271
Mailing Address - Fax:
Practice Address - Street 1:1578 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4353
Practice Address - Country:US
Practice Address - Phone:617-876-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA565171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist