Provider Demographics
NPI:1124370093
Name:FAIRFAX PULMONARY CONSULTING LLC
Entity Type:Organization
Organization Name:FAIRFAX PULMONARY CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ONEIL DIMITRY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-957-9119
Mailing Address - Street 1:880 N POLLARD ST
Mailing Address - Street 2:#501
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1738
Mailing Address - Country:US
Mailing Address - Phone:703-957-9119
Mailing Address - Fax:
Practice Address - Street 1:880 N POLLARD ST
Practice Address - Street 2:#501
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1738
Practice Address - Country:US
Practice Address - Phone:703-957-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019977207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty