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General NPI Number Information
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NPI Number | 1538362504
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Entity Type | Organization
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Legal Business Name | FAIRFAX NEONATAL ASSOCIATES, PC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 2730 PROSPERITY AVE STE A
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City | FAIRFAX
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State | VA
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Zip | 22031-4330
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Country | US
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Telephone | 703-289-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 PROSPERITY AVE # B
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City | FAIRFAX
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State | VA
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Zip | 22031-4329
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROJECT MANAGER
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Name | CAROLYN HALTERMAN
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Credential |
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Telephone | 703-289-1448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology 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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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