Healthcare Provider Details

I. General information

NPI: 1336503358
Provider Name (Legal Business Name): FAIRFAX HEARING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 GATEHOUSE RD 100
FALLS CHURCH VA
22042-1204
US

IV. Provider business mailing address

8120 GATEHOUSE RD 100
FALLS CHURCH VA
22042-1204
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-2771
  • Fax:
Mailing address:
  • Phone: 703-204-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2201001221
License Number StateVA

VIII. Authorized Official

Name: DR. LAURENCE R O'HALLORAN
Title or Position: PRESIDENT
Credential: MD
Phone: 703-204-2771