Healthcare Provider Details

I. General information

NPI: 1205802196
Provider Name (Legal Business Name): WOMEN'S HEATHCARE ASSOCIATES OF NORTHERN VIRGINIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 KINGSTOWNE VILLAGE PKWY SUITE 200
ALEXANDRIA VA
22315-5880
US

IV. Provider business mailing address

5901 KINGSTOWNE VILLAGE PKWY SUITE 200
ALEXANDRIA VA
22315-5880
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-3434
  • Fax: 703-922-6588
Mailing address:
  • Phone: 703-922-3434
  • Fax: 703-922-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK R. FRACASSO
Title or Position: PRESIDENT
Credential: MD
Phone: 703-922-3434