Provider Demographics
NPI:1255525895
Name:LOUDOUN RHEUMATOLOGY CENTER, PC
Entity type:Organization
Organization Name:LOUDOUN RHEUMATOLOGY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-723-3398
Mailing Address - Street 1:19465 DEERFIELD AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1700
Mailing Address - Country:US
Mailing Address - Phone:703-723-3398
Mailing Address - Fax:
Practice Address - Street 1:740 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3128
Practice Address - Country:US
Practice Address - Phone:540-338-7116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234395207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty