Provider Demographics
NPI:1780740993
Name:MACDONALD, GENEVIEVE A (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:A
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16200 VENTURA BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2205
Mailing Address - Country:US
Mailing Address - Phone:818-990-0595
Mailing Address - Fax:818-990-0553
Practice Address - Street 1:16200 VENTURA BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2205
Practice Address - Country:US
Practice Address - Phone:818-990-0595
Practice Address - Fax:818-990-0553
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG168522086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50939Medicare UPIN