Healthcare Provider Details

I. General information

NPI: 1306126297
Provider Name (Legal Business Name): MELODY NOLES HAWKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PROSPERITY AVE STE D
FAIRFAX VA
22031
US

IV. Provider business mailing address

2730 PROSPERITY AVE STE D
FAIRFAX VA
22031-4330
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-2290
  • Fax:
Mailing address:
  • Phone: 703-226-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101264901
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number0101264901
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0101264901
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: