Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 200101474 | NC |
Y | 207RA0401X | Internist - Addiction Medicine | 0101261562 | VA |
NPI | 1306920830 |
---|---|
Provider Name | Dr. Janice A Mcdonald |
First Address | Virginia Beach, VA 23455-6447 |
Second Address | Virginia Beach, VA 23455-6447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 28/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1302X | BCBS (01) | NC |
34D1040854 | CLIA (01) | NC |
891302X | (05) | NC |
F44687 | (02) | |
P00246669 | RAILROAD (01) | NC |