Healthcare Provider Details

I. General information

NPI: 1841468733
Provider Name (Legal Business Name): HAVEN J. BARLOW, JR., MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 ARLINGTON BLVD SUITE 420
FAIRFAX VA
22031-4625
US

IV. Provider business mailing address

8501 ARLINGTON BLVD SUITE 420
FAIRFAX VA
22031-4617
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-8844
  • Fax: 703-560-7270
Mailing address:
  • Phone: 703-560-8844
  • Fax: 703-560-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101046280
License Number StateVA

VIII. Authorized Official

Name: DR. HAVEN JESSE BARLOW JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 703-560-8844