Healthcare Provider Details

I. General information

NPI: 1235108986
Provider Name (Legal Business Name): JAMES P SIMSARIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT SUITE 400
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

3020 HAMAKER CT SUITE 400
FAIRFAX VA
22031-2238
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-0800
  • Fax: 703-876-0866
Mailing address:
  • Phone: 703-876-0800
  • Fax: 703-876-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number0101023418
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number0101023418
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101023418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: