Provider Demographics
NPI:1932804721
Name:MCDONALD, MATHESON ANNE (PAC)
Entity type:Individual
Prefix:MS
First Name:MATHESON
Middle Name:ANNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S LONG DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4835
Mailing Address - Country:US
Mailing Address - Phone:910-417-3000
Mailing Address - Fax:910-417-3709
Practice Address - Street 1:925 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4835
Practice Address - Country:US
Practice Address - Phone:910-417-3000
Practice Address - Fax:910-417-3709
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1932804721208M00000X
NC0010-13674363A00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1932804721Medicaid