Provider Demographics
NPI:1629074331
Name:FAIR, DENNIS L (PAC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:L
Last Name:FAIR
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:GARRISONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22463-0729
Mailing Address - Country:US
Mailing Address - Phone:540-657-9441
Mailing Address - Fax:540-657-4366
Practice Address - Street 1:422 GARRISONVILLE RD
Practice Address - Street 2:STE 111
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1573
Practice Address - Country:US
Practice Address - Phone:540-657-9441
Practice Address - Fax:540-657-4366
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41415Medicare UPIN
VA007224S99Medicare ID - Type Unspecified