Basic Information
| Provider Information | |||||||||
| NPI: | 1639304843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELLEN MCDONALD, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 FAIRMOUNT AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268724195 | ||||||||
| FaxNumber: | 6266281836 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 FAIRMOUNT AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268724195 | ||||||||
| FaxNumber: | 6266281836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2009 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
| AuthorizedOfficialMiddleName: | KATHLEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6268724195 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A102543 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.