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General NPI Number Information
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NPI Number | 1275564403
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Entity Type | Organization
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Legal Business Name | MCDONALD PEDIATRICS PC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 19415 DEERFIELD AVE STE 105
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City | LANSDOWNE
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State | VA
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Zip | 20176-8470
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Country | US
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Telephone | 571-223-2229
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Fax | 571-223-3299
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Provider Business Mailing Address
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Address Line | 19415 DEERFIELD AVE STE 105
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City | LANSDOWNE
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State | VA
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Zip | 20176-8470
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Country | US
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Telephone | 571-223-2229
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Fax | 571-223-3299
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | MRS. RUTH ISABEL MCDONALD
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Credential | MD PHD FAAP
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Telephone | 571-223-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101034278
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License Number State | VA
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