Healthcare Provider Details

I. General information

NPI: 1699863308
Provider Name (Legal Business Name): FAIRFAX NEONATAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730-C PROSPERITY AVENUE
FAIRFAX VA
22031
US

IV. Provider business mailing address

2730-C PROSPERITY AVENUE
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-2280
  • Fax: 703-752-1713
Mailing address:
  • Phone: 703-226-2280
  • Fax: 703-752-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number0101033509
License Number StateVA

VIII. Authorized Official

Name: DR. DANIEL EDWARD KEIM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 703-226-2280