Provider Demographics
NPI:1306836820
Name:ROSENBAUM, FAYE (MD)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR
Mailing Address - Street 2:#420
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3601
Mailing Address - Country:US
Mailing Address - Phone:703-536-4000
Mailing Address - Fax:703-527-4339
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:#420
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3601
Practice Address - Country:US
Practice Address - Phone:703-536-4000
Practice Address - Fax:703-527-4339
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010424152084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6100317Medicaid
157196N70Medicare ID - Type Unspecified
VA6100317Medicaid