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General NPI Number Information
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NPI Number | 1972525392
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Entity Type | Individual
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Provider Name | CRAIG R DUFRESNE M.D., F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 8501 ARLINGTON BLVD STE 420
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City | FAIRFAX
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State | VA
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Zip | 22031-4625
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Country | US
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Telephone | 703-207-3065
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Fax | 703-207-2002
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Provider Business Mailing Address
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Address Line | 8501 ARLINGTON BLVD STE 420
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City | FAIRFAX
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State | VA
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Zip | 22031-4625
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Country | US
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Telephone | 703-207-3065
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Fax | 703-207-2002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 52-2003266
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | MD17938
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | D0032266
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 0101043817
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License Number State | VA
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