Provider Demographics
NPI:1962494427
Name:MACDONALD, ALAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:50 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1348
Practice Address - Country:US
Practice Address - Phone:631-862-3064
Practice Address - Fax:631-862-3863
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY127473207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65F691Medicare ID - Type UnspecifiedINDIV #
NYW86891Medicare ID - Type UnspecifiedGROUP #
NYE62485Medicare UPIN