{
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"EIN": null,
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"OrgName": "FAIRFAX LUNG CENTER PC",
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"FirstLineMailingAddress": "2916 HIBBARD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAKTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22124-2648",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-242-0919",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3650 JOSEPH SIEWICK DR",
"SecondLinePracticeLocationAddress": "SUITE 303",
"PracticeLocationAddressCityName": "FAIRFAX",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22033-1710",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-389-1027",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/07/2008",
"LastUpdateDate": "02/02/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARTZELL",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "OSBORN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "703-389-1027",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RP1001X",
"TaxonomyName": "Pulmonary Disease Physician",
"LicenseNumber": "101239857",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}