Healthcare Provider Details

I. General information

NPI: 1528182706
Provider Name (Legal Business Name): FAIRFAX FAMILY PRACTICE CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 STONE SPRINGS BLVD STE 400
DULLES VA
20166-2268
US

IV. Provider business mailing address

381 ELDEN ST STE 1000
HERNDON VA
20170-4842
US

V. Phone/Fax

Practice location:
  • Phone: 703-766-5040
  • Fax: 703-766-5047
Mailing address:
  • Phone: 703-766-5040
  • Fax: 703-766-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID W LEE
Title or Position: PRESIDENT
Credential:
Phone: 703-766-5040