Provider Demographics
NPI:1467519298
Name:CHAMBERLAIN, LOUISE J (MD)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:J
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 S KING ST STE F
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3916
Mailing Address - Country:US
Mailing Address - Phone:703-777-5222
Mailing Address - Fax:
Practice Address - Street 1:823 S KING ST STE F
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3916
Practice Address - Country:US
Practice Address - Phone:703-777-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236330208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101236330OtherSTATE LICENSE
BC7318757OtherDEA