Provider Demographics
NPI:1083896476
Name:NORTH ARLINGTON FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:NORTH ARLINGTON FAMILY PRACTICE, PC
Other - Org Name:ASHTON AVENUE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-334-5801
Mailing Address - Street 1:6729 25TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22213-1102
Mailing Address - Country:US
Mailing Address - Phone:703-533-1550
Mailing Address - Fax:703-533-1578
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:703-334-5801
Practice Address - Fax:703-334-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA309288OtherANTHEM BC/BS
VA309288OtherANTHEM BC/BS