Healthcare Provider Details

I. General information

NPI: 1083695977
Provider Name (Legal Business Name): RUTH ISABEL MCDONALD MD PHD FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44081 PIPELINE PLAZA UNIT 125
ASHBURN VA
20147
US

IV. Provider business mailing address

44081 PIPELINE PLZ UNIT 125
ASHBURN VA
20147-5891
US

V. Phone/Fax

Practice location:
  • Phone: 517-223-2229
  • Fax: 571-223-3299
Mailing address:
  • Phone: 517-223-2229
  • Fax: 571-223-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101034278
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: