Provider Demographics
NPI:1255860474
Name:MACDONALD, ELISABETH ANN (PA)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:67 UNION STREET
Mailing Address - Street 2:MOB SUITE 308
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-655-4422
Mailing Address - Fax:508-655-9191
Practice Address - Street 1:67 UNION STREET
Practice Address - Street 2:MOB SUITE 308
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-655-4422
Practice Address - Fax:508-655-9191
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA6140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant