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General NPI Number Information
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NPI Number | 1174614978
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Entity Type | Organization
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Legal Business Name | VASCULAR LABORATORY OF FAIRFAX, LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 3020 HAMAKER CT SUITE 402
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City | FAIRFAX
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State | VA
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Zip | 22031-2238
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Country | US
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Telephone | 703-573-2400
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Fax | 703-207-9527
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Provider Business Mailing Address
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Address Line | 3020 HAMAKER CT SUITE 402
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City | FAIRFAX
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State | VA
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Zip | 22031-2238
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Country | US
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Telephone | 703-573-2400
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Fax | 703-207-9527
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAMES P SIMSARIAN
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Credential | M.D.
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Telephone | 703-573-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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