Provider Demographics
NPI:1306920830
Name:MCDONALD, JANICE A (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4509 WHITECHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6447
Mailing Address - Country:US
Mailing Address - Phone:757-460-4655
Mailing Address - Fax:757-460-7744
Practice Address - Street 1:4509 WHITECHAPEL DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6447
Practice Address - Country:US
Practice Address - Phone:757-460-4655
Practice Address - Fax:757-460-7744
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101474207N00000X
VA0101261562207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D1040854OtherCLIA
NCP00246669OtherRAILROAD
NC1302XOtherBCBS
NC891302XMedicaid
F44687Medicare UPIN
NC1302XOtherBCBS
NCP00246669OtherRAILROAD