Healthcare Provider Details

I. General information

NPI: 1770601825
Provider Name (Legal Business Name): FARRELL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11349 SUNSET HILLS RD
RESTON VA
20190-5205
US

IV. Provider business mailing address

11349 SUNSET HILLS RD
RESTON VA
20190-5205
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-0808
  • Fax: 703-435-4685
Mailing address:
  • Phone: 703-435-0808
  • Fax: 703-435-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHY NAJA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-327-0075