Basic Information
| Provider Information | |||||||||
| NPI: | 1558510792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACDONALD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ATHANASIUS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | V | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 417 STATE ST | ||||||||
| Address2: | WEBBER WEST, SUITE 141 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079734670 | ||||||||
| FaxNumber: | 2079734669 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 STATE ST | ||||||||
| Address2: | WEBBER WEST, SUITE 141 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079734670 | ||||||||
| FaxNumber: | 2079734669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD19475 | ME | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.