Healthcare Provider Details

I. General information

NPI: 1619763075
Provider Name (Legal Business Name): NORTHERN VIRGINIA HAND AND NERVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 510
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 510
FAIRFAX VA
22031-5216
US

V. Phone/Fax

Practice location:
  • Phone: 703-972-6655
  • Fax: 703-738-6454
Mailing address:
  • Phone: 703-972-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. HAILEY HAYCOX
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 703-972-6655