Healthcare Provider Details

I. General information

NPI: 1114721206
Provider Name (Legal Business Name): EMMA K FARBOTKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA K LAWRENCE MD

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

750 THORNTON WAY APT S-409
ALEXANDRIA VA
22314-4457
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-1803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101290412
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: