Provider Demographics
NPI:1013267442
Name:MCDONALD, MICHAEL ERIK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ERIK
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 369
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-2395
Mailing Address - Fax:617-636-1465
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 369
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-2395
Practice Address - Fax:617-636-1465
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2013-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0029980Medicare PIN