Healthcare Provider Details

I. General information

NPI: 1558337048
Provider Name (Legal Business Name): PAUL DAVID FALKENSTEIN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 CHAIN BRIDGE ROAD PUBLIC SAFETY OCCUPATIONAL HEALTH CENTER
FAIRFAX VA
22030
US

IV. Provider business mailing address

4080 CHAIN BRIDGE ROAD PUBLIC SAFETY OCCUPATIONAL HEALTH CENTER
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-4949
  • Fax: 703-352-0217
Mailing address:
  • Phone: 703-246-4949
  • Fax: 703-352-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-840389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: