Individual
GLENN JOHN MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M D
Contact information
Practice address
26 DAVISON AVE, OCEANSIDE, NY 11572-2237
(516) 764-7319
(561) 764-0804
Mailing address
26 DAVISON AVE, OCEANSIDE, NY 11572-2237
(516) 764-7319
(561) 764-0804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
158506
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15856
LICENSE
NY
Enumeration date
09/06/2006
Last updated
05/23/2022
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