Healthcare Provider Details

I. General information

NPI: 1851405708
Provider Name (Legal Business Name): JOHN DAVID FARRELL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25055 RIDING PLZ STE 150 SUITE 150
CHANTILLY VA
20152-5919
US

IV. Provider business mailing address

25055 RIDING PLZ STE 150 SUITE 150
CHANTILLY VA
20152-5919
US

V. Phone/Fax

Practice location:
  • Phone: 703-327-0075
  • Fax: 703-327-7977
Mailing address:
  • Phone: 703-327-0075
  • Fax: 703-327-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101054063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: