Basic Information
| Provider Information | |||||||||
| NPI: | 1508867474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONALDSON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N JUSTICE ST # 16 | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287913410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286948385 | ||||||||
| FaxNumber: | 8286947654 | ||||||||
| Practice Location | |||||||||
| Address1: | 1216 6TH AVE W | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286926262 | ||||||||
| FaxNumber: | 8286925858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 9900033 | NC | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | BD4615463 | 01 | DRUG ENFORCEMENT ADMIN | OTHER | 8911900 | 05 | NC | MEDICAID |