Healthcare Provider Details

I. General information

NPI: 1942294244
Provider Name (Legal Business Name): BURLINGTON PEDIATRIC ASSOCIATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S GEAR AVE SUITE 108
WEST BURLINGTON IA
52655-1685
US

IV. Provider business mailing address

1223 S GEAR AVE SUITE 108
WEST BURLINGTON IA
52655-1685
US

V. Phone/Fax

Practice location:
  • Phone: 319-753-5177
  • Fax: 319-753-0893
Mailing address:
  • Phone: 319-753-5177
  • Fax: 319-753-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18676
License Number StateIA

VIII. Authorized Official

Name: DR. DONALD R MCCABE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 319-753-5177