MEDICARE: STEPHEN W POURNARAS JR. M D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	0101037662	VA
2	207X00000X	Orthopaedic Surgery Physician	0101037662	VA
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	0101037662	VA

General Provider Information

NPI Number	:	1821088816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN W POURNARAS JR. M D

Provider Business Mailing Address
First Line	:	3998 FAIR RIDGE DR STE 100-A
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2907
Country	:	US
Telephone Number	:	703-591-0077
Fax Number	:	703-591-0080

Provider Business Practice Location Address
First Line	:	3998 FAIR RIDGE DR STE 100-A
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2907
Country	:	US
Telephone Number	:	703-591-0077
Fax Number	:	703-591-0080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	04/06/2026

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