Provider Demographics
NPI:1740696046
Name:WESTERN LOUDOUN PEDIATRICS
Entity type:Organization
Organization Name:WESTERN LOUDOUN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORFITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-751-8389
Mailing Address - Street 1:PO BOX 3309
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177-8125
Mailing Address - Country:US
Mailing Address - Phone:540-751-8389
Mailing Address - Fax:
Practice Address - Street 1:201 N MAPLE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6190
Practice Address - Country:US
Practice Address - Phone:540-751-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care