Healthcare Provider Details

I. General information

NPI: 1720006497
Provider Name (Legal Business Name): JOHN J HYNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3129
  • Fax: 703-295-9369
Mailing address:
  • Phone: 703-295-9360
  • Fax: 103-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101039546
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: