Organization
CSSSDWC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN M WATTENMAKER M.D (DOCTOR)
(703) 777-1553
Entity
Organization
Contact information
Practice address
224D CORNWALL ST NW, SUITE 204, LEESBURG, VA 20176-2700
(703) 777-1553
(703) 777-5524
Mailing address
PO BOX 17334, BALTIMORE, MD 21297-1334
(703) 443-6717
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Enumeration date
11/03/2011
Last updated
11/03/2011
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