Provider Demographics
NPI:1053367805
Name:MCDONALD, EDWARD NATHAN (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:NATHAN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 OLD STATE RD # 19
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813-9616
Mailing Address - Country:US
Mailing Address - Phone:585-268-5700
Mailing Address - Fax:
Practice Address - Street 1:5877 OLD STATE RD # 19
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9616
Practice Address - Country:US
Practice Address - Phone:585-268-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY464017Medicaid
NY464017Medicaid
NYRB6000Medicare PIN
NYBB4512Medicare PIN