Provider Demographics
NPI:1205565728
Name:MCDONALD, RAYMOND S (LAC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:S
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10424 HUNTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3853
Mailing Address - Country:US
Mailing Address - Phone:301-254-5245
Mailing Address - Fax:
Practice Address - Street 1:7300 GRACE DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2473
Practice Address - Country:US
Practice Address - Phone:240-389-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist