Provider Demographics
NPI:1275564403
Name:MCDONALD PEDIATRICS PC
Entity Type:Organization
Organization Name:MCDONALD PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD FAAP
Authorized Official - Phone:571-223-2229
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8470
Mailing Address - Country:US
Mailing Address - Phone:571-223-2229
Mailing Address - Fax:571-223-3299
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:STE 105
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8470
Practice Address - Country:US
Practice Address - Phone:571-223-2229
Practice Address - Fax:571-223-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F83325Medicare UPIN