Provider Demographics
NPI:1639179476
Name:MCDONALD, PATRICIA A (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MAIN ST PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-9992
Mailing Address - Country:US
Mailing Address - Phone:860-539-9136
Mailing Address - Fax:860-826-4436
Practice Address - Street 1:210 MAIN STREET PO BOX 38
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-9992
Practice Address - Country:US
Practice Address - Phone:860-539-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004214433Medicaid
CT1255448155OtherGHMC GROUP NPI ID
CT060065OtherHEALTH NET
CT481607OtherAETNA
CTP369883OtherOXFORD
CT010024751CT02OtherBCBS & BCFP ID
CT01024751OtherCIGNA
CT138005OtherWELLCARE MEDICARE
CT180024412OtherRAIL ROAD MEDICARE ID
CT7939301OtherCONNECTICARE
CT001247519Medicare ID - Type Unspecified
CT004214433Medicaid
CTC01373Medicare ID - Type UnspecifiedGHMC GROUP MEDICARE ID
A64589Medicare UPIN