Provider Demographics
NPI:1316125727
Name:MCDONALD, JAMES LACHLAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LACHLAN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5872
Mailing Address - Country:US
Mailing Address - Phone:207-945-6287
Mailing Address - Fax:
Practice Address - Street 1:323 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5872
Practice Address - Country:US
Practice Address - Phone:207-945-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS784103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7078Medicare PIN