Provider Demographics
NPI:1982696985
Name:MACDONALD, DONALD A JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:MACDONALD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21N GILBERT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4913
Mailing Address - Country:US
Mailing Address - Phone:732-741-1902
Mailing Address - Fax:732-741-1919
Practice Address - Street 1:21 N GILBERT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4913
Practice Address - Country:US
Practice Address - Phone:732-741-1902
Practice Address - Fax:732-741-1919
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04441400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ018320201Medicaid
NJP00380298OtherRAILRAOD MEDICARE
A60214Medicare UPIN
NJ0176820001Medicare NSC
NJ018320201Medicaid