Provider Demographics
NPI:1265789184
Name:MCDONALD, AMBER A (PA)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:A
Other - Last Name:PANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:656 COLEMAN BLVD UNIT 902
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6011
Mailing Address - Country:US
Mailing Address - Phone:843-568-4137
Mailing Address - Fax:
Practice Address - Street 1:5 E 98TH ST # 1259
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant