Provider Demographics
NPI:1942395116
Name:MACKAY, DONNA JANE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JANE
Last Name:MACKAY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 INDUSTRIAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1610
Mailing Address - Country:US
Mailing Address - Phone:610-647-4161
Mailing Address - Fax:610-647-5397
Practice Address - Street 1:21 INDUSTRIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1610
Practice Address - Country:US
Practice Address - Phone:610-647-4161
Practice Address - Fax:610-647-5397
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021206E207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30268Medicare UPIN