Healthcare Provider Details

I. General information

NPI: 1548363609
Provider Name (Legal Business Name): JOHN FANO SCHULTZE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

PO BOX 759101
BATIMORE MA
21275
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-3111
  • Fax: 904-346-0113
Mailing address:
  • Phone: 703-205-9790
  • Fax: 904-596-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: