Provider Demographics
NPI:1881882090
Name:LOUDOUN FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:LOUDOUN FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUDSIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-858-9192
Mailing Address - Street 1:19450 DEERFIELD AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8424
Mailing Address - Country:US
Mailing Address - Phone:703-858-9192
Mailing Address - Fax:703-858-9442
Practice Address - Street 1:19450 DEERFIELD AVE STE 150
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8424
Practice Address - Country:US
Practice Address - Phone:703-858-9192
Practice Address - Fax:703-858-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010133688Medicaid
VA010133688Medicaid
VAC09324Medicare PIN