Provider Demographics
NPI:1912997156
Name:MACQUEEN, DONALD MILES (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MILES
Last Name:MACQUEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6012
Mailing Address - Country:US
Mailing Address - Phone:910-763-1661
Mailing Address - Fax:910-251-8595
Practice Address - Street 1:2321 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6012
Practice Address - Country:US
Practice Address - Phone:910-763-1661
Practice Address - Fax:910-251-8595
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16434207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953695Medicaid
NC201471BMedicare ID - Type Unspecified
NC8953695Medicaid