Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | R176702 | MD |
NPI | 1215284815 |
---|---|
Provider Name | Mr. Patrick Matthew Mcdonald |
First Address | Aberdeen, MD 21001-2428 |
Second Address | Aberdeen, MD 21001-2428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 12/02/2016 |