Individual
LINDA A. WAGGONER FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1204 W MAIN ST, CHARLOTTESVILLE, VA 22903-2824
(434) 924-0123
(434) 243-3300
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101048721
VA
2080P0208X
Pediatric Infectious Diseases Physician
Primary
0101048721
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013086651
—
VA
Enumeration date
11/07/2006
Last updated
08/10/2023
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