Provider Demographics
NPI:1932291572
Name:MACDONALD, ANDRE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:JOHN
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1987
Mailing Address - Country:US
Mailing Address - Phone:828-213-0594
Mailing Address - Fax:828-213-0590
Practice Address - Street 1:534 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4612
Practice Address - Country:US
Practice Address - Phone:828-213-0594
Practice Address - Fax:828-213-0590
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5211171-12052085R0202X, 2085N0700X
NC2007-012422085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4942Medicaid
NC1471MOtherBCBS NC
NC5908037Medicaid
NC2072896AMedicare PIN
UT000059496Medicare PIN
NC1471MOtherBCBS NC
NC5908037Medicaid