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General NPI Number Information
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NPI Number | 1013087394
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Entity Type | Organization
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Legal Business Name | FAIR OAKS INTERNAL MEDICINE
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 10721 MAIN ST #1500
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-218-2970
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Fax | 703-218-2965
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Provider Business Mailing Address
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Address Line | 10721 MAIN ST #1500
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City | FAIRFAX
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State | VA
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Zip | 22030-6914
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Country | US
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Telephone | 703-218-2970
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Fax | 703-218-2965
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Authorized Official
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Title or Position | MD
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Name | JOHN J MATHEWS JR.
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Credential | MD
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Telephone | 703-218-2970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | VA
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