Provider Demographics
NPI:1356501753
Name:INOVA FAIRFAX HOSPITAL
Entity Type:Organization
Organization Name:INOVA FAIRFAX HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:SHILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-575-4718
Mailing Address - Street 1:1504 LINCOLN WAY
Mailing Address - Street 2:UNIT 118
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5851
Mailing Address - Country:US
Mailing Address - Phone:917-575-4718
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-7834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018750261Q00000X, 282NC0060X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access