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General NPI Number Information
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NPI Number | 1750698239
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGY AT BURKE, LLC
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 9408 RAINTREE RD
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City | BURKE
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State | VA
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Zip | 22015-1946
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Country | US
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Telephone | 703-426-7246
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Fax | 703-426-4223
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Provider Business Mailing Address
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Address Line | 9408 RAINTREE RD
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City | BURKE
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State | VA
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Zip | 22015-1946
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Country | US
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Telephone | 703-426-7246
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Fax | 703-426-4223
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL FEDIO
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Credential | PH.D.
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Telephone | 703-426-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0810002714
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License Number State | VA
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