Healthcare Provider Details

I. General information

NPI: 1427324722
Provider Name (Legal Business Name): FAIR OAKS SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR STE 408
FAIRFAX VA
22033-1745
US

IV. Provider business mailing address

PO BOX 221135
CHANTILLY VA
20153-1135
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3620
  • Fax: 703-391-3713
Mailing address:
  • Phone: 703-391-3620
  • Fax: 703-391-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: ESAM AL NOUMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 703-391-3620