Provider Demographics
NPI:1154872364
Name:MCDONALD, KERRI (PA-C)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK CENTER CT STE 200
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4221
Mailing Address - Country:US
Mailing Address - Phone:443-693-7246
Mailing Address - Fax:443-450-3204
Practice Address - Street 1:8100 SANDPIPER CIR STE 214
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4999
Practice Address - Country:US
Practice Address - Phone:443-693-7246
Practice Address - Fax:410-870-6026
Is Sole Proprietor?:No
Enumeration Date:2016-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06275363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical