Provider Demographics
NPI:1356958003
Name:MCDONALD, CAMERON ALLEN (RD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ALLEN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 PUTNAM AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4834
Mailing Address - Country:US
Mailing Address - Phone:704-942-5002
Mailing Address - Fax:
Practice Address - Street 1:567 PUTNAM AVE APT 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4834
Practice Address - Country:US
Practice Address - Phone:704-942-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86073905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered