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General NPI Number Information
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NPI Number | 1679819296
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Entity Type | Organization
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Legal Business Name | FAIRFAX NEONATAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 2730-D PROSPERITY AVENUE
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-226-2290
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Fax | 703-226-2291
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Provider Business Mailing Address
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Address Line | 2730-D PROSPERITY AVENUE
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-226-2290
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Fax | 703-226-2291
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GLENNA B WINNIE
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Credential | MD
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Telephone | 703-226-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0012X
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Taxonomy Name | Pediatric Sleep Medicine Physician
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License Number | 0101234661
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License Number State | VA
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