Provider Demographics
NPI:1134611759
Name:MCDONALD, LEROY GLYNN
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:GLYNN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FESTIVAL CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3170
Mailing Address - Country:US
Mailing Address - Phone:202-821-6275
Mailing Address - Fax:
Practice Address - Street 1:800 FESTIVAL CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3170
Practice Address - Country:US
Practice Address - Phone:202-821-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant