Provider Demographics
NPI:1962584342
Name:MACDONALD, LORRAINE A (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 HART LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37243-0801
Mailing Address - Country:US
Mailing Address - Phone:615-650-7037
Mailing Address - Fax:615-262-6139
Practice Address - Street 1:710 HART LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-0801
Practice Address - Country:US
Practice Address - Phone:615-650-7037
Practice Address - Fax:615-262-6139
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN24807OtherMD LICENSE
TNBM3839721OtherDEA LICENSE
TNF75642Medicare UPIN