Provider Demographics
NPI:1821476698
Name:MACDONALD, STEPHANIE M (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MACDONALD
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 665
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5321
Mailing Address - Fax:
Practice Address - Street 1:2064 FAIRPORT NINE MILE POINT RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1750
Practice Address - Country:US
Practice Address - Phone:585-275-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293859207QS0010X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine