Provider Demographics
NPI:1649334285
Name:RICHARD MACDONELL MD PC
Entity type:Organization
Organization Name:RICHARD MACDONELL MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MAC DONELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-322-6869
Mailing Address - Street 1:2190 NE PROFESSIONAL CT
Mailing Address - Street 2:#200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6065
Mailing Address - Country:US
Mailing Address - Phone:541-322-6869
Mailing Address - Fax:541-639-3655
Practice Address - Street 1:2190 NE PROFESSIONAL CT
Practice Address - Street 2:#200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6065
Practice Address - Country:US
Practice Address - Phone:541-322-6869
Practice Address - Fax:541-639-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty