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General NPI Number Information
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NPI Number | 1205944964
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Entity Type | Organization
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Legal Business Name | FAIRFAX FAMILY PRACTICE CENTERS PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 381 ELDEN ST STE 1000
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City | HERNDON
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State | VA
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Zip | 20170-4842
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Country | US
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Telephone | 703-481-1501
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Fax | 703-742-8793
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Provider Business Mailing Address
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Address Line | 381 ELDEN ST STE 1000
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City | HERNDON
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State | VA
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Zip | 20170-4842
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Country | US
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Telephone | 703-481-1501
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Fax | 703-742-8793
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID W LEE
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Credential | MD
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Telephone | 703-424-6338
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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 |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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