Healthcare Provider Details

I. General information

NPI: 1275564403
Provider Name (Legal Business Name): MCDONALD PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 105
LANSDOWNE VA
20176-8470
US

IV. Provider business mailing address

19415 DEERFIELD AVE STE 105
LANSDOWNE VA
20176-8470
US

V. Phone/Fax

Practice location:
  • Phone: 571-223-2229
  • Fax: 571-223-3299
Mailing address:
  • Phone: 571-223-2229
  • 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: MRS. RUTH ISABEL MCDONALD
Title or Position: OWNER PHYSICIAN
Credential: MD PHD FAAP
Phone: 571-223-2229