Individual
MARY COLLEEN MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 WESTERN AVE, CAMBRIDGE, MA 02139-3750
(617) 575-5620
Mailing address
205 WESTERN AVE, CAMBRIDGE, MA 02139-3750
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
186295
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP4032
BCBS MA
MA
Enumeration date
12/11/2006
Last updated
11/01/2007
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