Healthcare Provider Details

I. General information

NPI: 1104194570
Provider Name (Legal Business Name): FAIRFAX PULMONARY & CRITICAL CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ARLINGTON BLVD SUITE T5
FAIRFAX VA
22031-2902
US

IV. Provider business mailing address

8301 ARLINGTON BLVD SUITE T5
FAIRFAX VA
22031-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-2273
  • Fax:
Mailing address:
  • Phone: 703-208-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EYAD ABU-HAMDA
Title or Position: OWNER
Credential:
Phone: 703-208-2273