Provider Demographics
NPI:1194977470
Name:VON WALTER, ASTRID R (MD)
Entity type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:R
Last Name:VON WALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ASTRID
Other - Middle Name:VON
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:224-D CORNWALL STREET, NW.
Mailing Address - Street 2:SUITE 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:703-737-6010
Practice Address - Street 1:1800 TOWN CENTER DRIVE, SUITE 220
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3238
Practice Address - Country:US
Practice Address - Phone:703-435-2555
Practice Address - Fax:571-926-8910
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112314207V00000X
DCMD040397207VG0400X
VA0101277563207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194977470Medicaid
VA30016765820002Medicaid