Provider Demographics
NPI:1235309816
Name:LITTLE FALLS FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:LITTLE FALLS FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:FOX
Authorized Official - Last Name:BARTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-237-7707
Mailing Address - Street 1:407 N WASHINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3436
Mailing Address - Country:US
Mailing Address - Phone:703-237-7707
Mailing Address - Fax:703-241-1261
Practice Address - Street 1:407 N WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3436
Practice Address - Country:US
Practice Address - Phone:703-237-7707
Practice Address - Fax:703-241-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB92892Medicare UPIN
VABA33965Medicare PIN
VAH02399Medicare UPIN