Individual
IAN MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 W SQUANTUM ST, QUINCY, MA 02171-2122
(617) 376-2038
Mailing address
110 W SQUANTUM ST, QUINCY, MA 02171-2122
(617) 376-2038
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
S39089913
MA
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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