Provider Demographics
NPI:1942415146
Name:MACDOUGALL, DONALD B (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:MACDOUGALL
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 1:75 FISCHER CIR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-5409
Mailing Address - Country:US
Mailing Address - Phone:401-849-0833
Mailing Address - Fax:
Practice Address - Street 1:11 FRIENDSHIP ST
Practice Address - Street 2:PATHOLOGY-LAB, HAZARD 3
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2209
Practice Address - Country:US
Practice Address - Phone:401-845-1284
Practice Address - Fax:401-845-1990
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD8012207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003132Medicaid
RIB41969Medicare UPIN
RI7003132Medicaid