Provider Demographics
NPI:1386622272
Name:DONALD, MARK LOUIS II (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOUIS
Last Name:DONALD
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9633 WARWICK AVE
Mailing Address - Street 2:UNIT A6
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-2121
Mailing Address - Country:US
Mailing Address - Phone:619-248-1544
Mailing Address - Fax:
Practice Address - Street 1:1721 TAUSSIG BLVD.
Practice Address - Street 2:BRANCH MEDICAL CLINIC, NAVSTA NORFOLK, MACD
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2899
Practice Address - Country:US
Practice Address - Phone:757-314-6301
Practice Address - Fax:757-314-6233
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical