Healthcare Provider Details

I. General information

NPI: 1245218684
Provider Name (Legal Business Name): VIRGINIA SURGERY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13135 LEE JACKSON MEMORIAL HWY STE 305
FAIRFAX VA
22033-1907
US

IV. Provider business mailing address

13135 LEE JACKSON MEMORIAL HWY STE 305
FAIRFAX VA
22033-1907
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-8640
  • Fax: 703-591-6104
Mailing address:
  • Phone: 703-359-8640
  • Fax: 703-591-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. LORRIE J HALL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-359-8640