Provider Demographics
NPI:1043452675
Name:BLMD OF LOUDOUN, INC.
Entity type:Organization
Organization Name:BLMD OF LOUDOUN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-799-5816
Mailing Address - Street 1:46165 WESTLAKE DR
Mailing Address - Street 2:100
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5872
Mailing Address - Country:US
Mailing Address - Phone:888-799-5816
Mailing Address - Fax:703-433-9386
Practice Address - Street 1:46165 WESTLAKE DR
Practice Address - Street 2:100
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5872
Practice Address - Country:US
Practice Address - Phone:888-799-5816
Practice Address - Fax:703-433-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101050030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty