Healthcare Provider Details

I. General information

NPI: 1194925743
Provider Name (Legal Business Name): JUSTIN P FOX MD, MHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JONES BRIDGE RD DEPT OF
BETHESDA MD
20814-4799
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4664
  • Fax:
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101244227
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101244227
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberNOT YET ISSUED
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: