Basic Information
| Provider Information | |||||||||
| NPI: | 1306004544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | BASIL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 379 CAMPUS DR FL 4 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088731161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325076545 | ||||||||
| FaxNumber: | 9083895675 | ||||||||
| Practice Location | |||||||||
| Address1: | 3575 QUAKERBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086191271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096312800 | ||||||||
| FaxNumber: | 6096312896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | MT188382 | PA | N | Hospitals | General Acute Care Hospital | Children | 208000000X | 25MA09461100 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.