Healthcare Provider Details

I. General information

NPI: 1720168255
Provider Name (Legal Business Name): FURST OFFICE BASED SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 BACKLICK RD
SPRINGFIELD VA
22151-3906
US

IV. Provider business mailing address

5504 BACKLICK RD
SPRINGFIELD VA
22151-3906
US

V. Phone/Fax

Practice location:
  • Phone: 703-941-9552
  • Fax:
Mailing address:
  • Phone: 703-941-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC JONATHAN FURST
Title or Position: C.E.O.
Credential: M.D.
Phone: 703-941-9552