Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G64015 | CA |
N | 207N00000X | Dermatologist | MD9123 | HI |
N | 207ND0101X | MOHS-Micrographic Surgeon | G64015 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD9123 | HI |
NPI | 1063484988 |
---|---|
Provider Name | Dr. Marian Lee Macdonald |
First Address | San Diego, CA 92107-2908 |
Second Address | San Diego, CA 92161-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 08/07/2007 |