Healthcare Provider Details

I. General information

NPI: 1194977470
Provider Name (Legal Business Name): ASTRID R VON WALTER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASTRID VON GONZALEZ M.D.

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TOWN CENTER DRIVE, SUITE 220
RESTON VA
20190-3238
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW. SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-2555
  • Fax: 571-926-8910
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-737-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101277563
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number112314
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD040397
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: