{
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"FirstLineMailingAddress": "7910 ANDRUS RD",
"SecondLineMailingAddress": "#6",
"MailingAddressCityName": "ALEXANDRIA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22306-3171",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-799-1688",
"MailingAddressFaxNumber": "703-799-4092",
"FirstLinePracticeLocationAddress": "7910 ANDRUS RD",
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"PracticeLocationAddressTelephoneNumber": "703-799-1688",
"PracticeLocationAddressFaxNumber": "703-799-4092",
"EnumerationDate": "05/03/2007",
"LastUpdateDate": "05/03/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NAIDORF",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "0101043875",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}