Provider Demographics
NPI:1134902505
Name:MCDONALD, TABITHA RANDIA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:RANDIA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 NEW BERN AVE STE 137
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1372
Mailing Address - Country:US
Mailing Address - Phone:919-520-2936
Mailing Address - Fax:
Practice Address - Street 1:4111 NEW BERN AVE STE 137
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1372
Practice Address - Country:US
Practice Address - Phone:919-520-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy