MEDICARE: BLMD OF LOUDOUN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	101050030	VA

General Provider Information

NPI Number	:	1043452675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLMD OF LOUDOUN, INC.

Provider Business Mailing Address
First Line	:	46165 WESTLAKE DR
Second Line	:	100
City	:	POTOMAC FALLS
State	:	VA
Zip	:	20165-5872
Country	:	US
Telephone Number	:	888-799-5816
Fax Number	:	703-433-9386

Provider Business Practice Location Address
First Line	:	46165 WESTLAKE DR
Second Line	:	100
City	:	POTOMAC FALLS
State	:	VA
Zip	:	20165-5872
Country	:	US
Telephone Number	:	888-799-5816
Fax Number	:	703-433-9386

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. HEIDI ARCHER
Credential	:	M.D.
Telephone Number	:	888-799-5816

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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