Provider Demographics
NPI:1730149758
Name:MCDONALD, KERRY A (NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LEOMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-2114
Mailing Address - Country:US
Mailing Address - Phone:978-422-7774
Mailing Address - Fax:978-422-9089
Practice Address - Street 1:1400 COMPUTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1790
Practice Address - Country:US
Practice Address - Phone:617-420-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252733363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA18698OtherHARVARD PILGRIM
MA0701068Medicaid
MANP4776OtherBLUE CROSS
MAAA18698OtherHARVARD PILGRIM
MAQ26228Medicare UPIN