Healthcare Provider Details

I. General information

NPI: 1114359080
Provider Name (Legal Business Name): FAIRFAX WOMENS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 ARLINGTON BLVD SUITE 500
FAIRFAX VA
22031-4617
US

IV. Provider business mailing address

8501 ARLINGTON BLVD SUITE 500
FAIRFAX VA
22031-4617
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-6311
  • Fax: 703-876-6317
Mailing address:
  • Phone: 703-876-6311
  • Fax: 703-876-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number0101045286
License Number StateVA

VIII. Authorized Official

Name: NANCY M DURSO
Title or Position: MD
Credential: MD
Phone: 703-876-6311