Individual
IAN MICHAEL WATTENMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19450 DEERFIELD AVENUE, SUITE 200, LEESBURG, VA 20176-6821
(703) 777-1553
(703) 777-5524
Mailing address
224D CORNWALL ST NW STE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101049672
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629077854
—
VA
05
—
30015845120002
—
VA
Enumeration date
07/19/2005
Last updated
03/18/2024
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