| Ian Michael Wattenmaker, MD | |
|
19450 Deerfield Avenue, Suite 200, Leesburg, VA 20176-6821 | |
| (703) 777-1553 | |
| (703) 777-5524 |
| Full Name | Ian Michael Wattenmaker |
|---|---|
| Gender | Male |
| Speciality | Orthopaedic Surgery |
| Location | 19450 Deerfield Avenue, Suite 200, Leesburg, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629077854 | NPI | - | NPPES |
| 30015845120002 | Medicaid | VA | |
| 1629077854 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | 0101049672 (Virginia) | Primary |
| Entity Name | Loudoun Medical Group, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679591440 PECOS PAC ID: 0042119661 Enrollment ID: O20041115000474 |
| Mailing Address | Practice Location Address |
|---|---|
| Ian Michael Wattenmaker, MD 224d Cornwall St Nw Ste 403, Leesburg, VA 20176-2704 Ph: (703) 737-6010 | Ian Michael Wattenmaker, MD 19450 Deerfield Avenue, Suite 200, Leesburg, VA 20176-6821 Ph: (703) 777-1553 |
Dr. Nauman J Akhtar, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 224-d Cornwall Street Nw, Suite 204, Leesburg, VA 20176 Phone: 703-777-3262 Fax: 703-777-3365 | |
Matthew Bernard Gavin, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 224-d Cornwall Street, Nw, Suite 204,, Leesburg, VA 20176 Phone: 703-777-3262 Fax: 703-777-3365 | |
Raymond Francis Lower, D.O. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 19465 Deerfield Ave Ste 405, Leesburg, VA 20176 Phone: 703-858-1800 Fax: 703-858-1801 | |
Dr. Abdurrahman Kandil, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 224-d Cornwall Street, Nw, Suite 204,, Leesburg, VA 20176 Phone: 703-665-2720 Fax: 703-665-2487 | |
Dr. Ali Moshirfar, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 19450 Deerfield Ave Ste 300, Leesburg, VA 20176 Phone: 703-723-6774 Fax: 703-723-1494 | |
Dr. James Ticknor Gable, DO Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 224 D Cornwall Street Nw, Suite 204, Leesburg, VA 20176 Phone: 703-777-3262 Fax: 703-777-3365 | |
Michael Andrew Kavanagh, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 224-d Cornwall Street, Nw, Suite 204, Leesburg, VA 20176 Phone: 703-777-3262 Fax: 703-777-3365 |