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General NPI Number Information
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NPI Number | 1821055609
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Entity Type | Organization
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Legal Business Name | FAIRFAX NEONATAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 3060 WILLIAMS DRIVE SUITE 520
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City | FAIRFAX
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State | VA
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Zip | 22031-4648
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Country | US
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Telephone | 703-289-1400
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Fax | 703-289-1414
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Provider Business Mailing Address
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Address Line | 3060 WILLIAMS DRIVE SUITE 520
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City | FAIRFAX
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State | VA
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Zip | 22031-4648
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Country | US
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Telephone | 703-289-1400
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Fax | 703-289-1414
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Authorized Official
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Title or Position | EVP, COO
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Name | MR. GREGORY EDWARD BENGSTON
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Credential |
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Telephone | 703-289-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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