Organization
VITA FAMILY MEDICINE AND MEDSPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER BOUDREAU M.D (OWNER/DOCTOR)
(717) 805-8264
Entity
Organization
Contact information
Practice address
540 FORT EVANS RD, SUITE 204, LEESBURG, VA 20176-3379
(703) 737-3500
(703) 737-3550
Mailing address
540 FORT EVANS RD, SUITE 204, LEESBURG, VA 20176-3379
(703) 737-3500
(703) 737-3550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
VA
261QP2300X
Primary Care Clinic/Center
0101258315
VA
Other
Enumeration date
07/19/2016
Last updated
10/13/2016
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