Provider Demographics
NPI:1487699161
Name:HUDLER, ANNETTE MARIE (DO)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:HUDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:MARIE
Other - Last Name:ANTOLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:205 E. HIRST ROAD, SUITE 203
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6600
Practice Address - Country:US
Practice Address - Phone:540-751-0255
Practice Address - Fax:540-751-0466
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487699161Medicaid
VA30015898370001Medicaid
G86080Medicare UPIN