Healthcare Provider Details

I. General information

NPI: 1629017645
Provider Name (Legal Business Name): LOUDOUN ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46161 WESTLAKE DR SUITE 200
POTOMAC FALLS VA
20165-5871
US

IV. Provider business mailing address

46161 WESTLAKE DR SUITE 200
POTOMAC FALLS VA
20165-5871
US

V. Phone/Fax

Practice location:
  • Phone: 703-433-9230
  • Fax: 703-433-9248
Mailing address:
  • Phone: 703-433-9230
  • Fax: 703-433-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CONOR A. BEARDSLEY
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 703-433-9252