Provider Demographics
NPI:1982672747
Name:SPOONER, ANNEMARIE ALYSE (MD)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:ALYSE
Last Name:SPOONER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:21475 RIDGETOP CIRCLE, SUITE 210
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8505
Practice Address - Country:US
Practice Address - Phone:703-858-2811
Practice Address - Fax:571-375-0383
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236039207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015969450001Medicaid
VAP00324038OtherRR MEDICARE
VA010250889Medicaid
VA1982672747Medicaid