Healthcare Provider Details

I. General information

NPI: 1720038342
Provider Name (Legal Business Name): GLENN H FUCHS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 ARLINGTON BLVD STE 102
FALLS CHURCH VA
22042-3000
US

IV. Provider business mailing address

6565 ARLINGTON BLVD STE 102
FALLS CHURCH VA
22042-3000
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-1770
  • Fax: 703-820-7088
Mailing address:
  • Phone: 703-578-1770
  • Fax: 703-820-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD12067
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101033724
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101033724
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: