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General NPI Number Information
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NPI Number | 1609922293
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Entity Type | Organization
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Legal Business Name | WHOLE HEALTH FAMILY & SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 209 OLD WATERFORD RD NW
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City | LEESBURG
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State | VA
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Zip | 20176-2116
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Country | US
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Telephone | 703-779-9300
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Fax | 703-779-9733
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Provider Business Mailing Address
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Address Line | 209 OLD WATERFORD RD NW
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City | LEESBURG
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State | VA
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Zip | 20176-2116
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Country | US
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Telephone | 703-779-9300
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Fax | 703-779-9733
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Authorized Official
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Title or Position | OWNER
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Name | DAVID W STEWART
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Credential | MD
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Telephone | 703-779-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101234440
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License Number State | VA
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