Provider Demographics
NPI:1679819296
Name:FAIRFAX NEONATAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:FAIRFAX NEONATAL ASSOCIATES, P.C.
Other - Org Name:PEDIATRIC AND ADOLESCENT SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-226-2290
Mailing Address - Street 1:2730-D PROSPERITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-226-2290
Mailing Address - Fax:703-226-2291
Practice Address - Street 1:2730-D PROSPERITY AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-226-2290
Practice Address - Fax:703-226-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012346612080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Multi-Specialty