Provider Demographics
NPI:1437468311
Name:FAIRFAXMD, PLLC
Entity Type:Organization
Organization Name:FAIRFAXMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-229-4455
Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6908
Mailing Address - Country:US
Mailing Address - Phone:703-229-4455
Mailing Address - Fax:703-229-4454
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 3300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6908
Practice Address - Country:US
Practice Address - Phone:703-229-4455
Practice Address - Fax:703-229-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty