1083695977 NPI number — DR. RUTH ISABEL MCDONALD MD PHD FAAP

Table of content: DR. RUTH ISABEL MCDONALD MD PHD FAAP (NPI 1083695977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083695977 NPI number — DR. RUTH ISABEL MCDONALD MD PHD FAAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
RUTH
Provider Middle Name:
ISABEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD FAAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083695977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44081 PIPELINE PLZ
Provider Second Line Business Mailing Address:
UNIT 125
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-5891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-223-2229
Provider Business Mailing Address Fax Number:
571-223-3299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44081 PIPELINE PLAZA
Provider Second Line Business Practice Location Address:
UNIT 125
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-223-2229
Provider Business Practice Location Address Fax Number:
571-223-3299
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0101034278 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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