Provider Demographics
NPI:1952589145
Name:MARILYN R. MCDONALD MD
Entity Type:Organization
Organization Name:MARILYN R. MCDONALD MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-861-8977
Mailing Address - Street 1:522 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1180
Mailing Address - Country:US
Mailing Address - Phone:610-861-8977
Mailing Address - Fax:610-861-9339
Practice Address - Street 1:522 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1180
Practice Address - Country:US
Practice Address - Phone:610-861-8977
Practice Address - Fax:610-861-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035461E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0921580002Medicare NSC
PA156167Medicare PIN
PAC32184Medicare UPIN