Provider Demographics
NPI:1629180138
Name:ROBERT A MCDONALD SR DDB PC
Entity Type:Organization
Organization Name:ROBERT A MCDONALD SR DDB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANGUS
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-751-5222
Mailing Address - Street 1:50 SOUTH PICKETT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-751-5222
Mailing Address - Fax:703-751-5210
Practice Address - Street 1:50 SOUTH PICKETT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-751-5222
Practice Address - Fax:703-751-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401002256261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental