Healthcare Provider Details

I. General information

NPI: 1265616981
Provider Name (Legal Business Name): CNMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ARLINGTON BLVD SUITE 209
FAIRFAX VA
22031-2902
US

IV. Provider business mailing address

8301 ARLINGTON BLVD SUITE 209
FAIRFAX VA
22031-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-9111
  • Fax: 703-698-8338
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number0101242846
License Number StateVA

VIII. Authorized Official

Name: DR. MAX COPPES
Title or Position: MD
Credential: MD
Phone: 202-476-5000