Healthcare Provider Details

I. General information

NPI: 1104163542
Provider Name (Legal Business Name): FAIRFAX ARRHYTHMIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT SUITE 401
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

PO BOX 503
MERRIFIELD VA
22116-0503
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-7257
  • Fax:
Mailing address:
  • Phone: 703-208-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0101232709
License Number StateVA

VIII. Authorized Official

Name: DAVID STROUSE
Title or Position: PARTNER
Credential: MD
Phone: 703-208-7257