Provider Demographics
NPI:1821084872
Name:DR N HINES & T FAHY
Entity Type:Organization
Organization Name:DR N HINES & T FAHY
Other - Org Name:CARDINAL PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-281-1108
Mailing Address - Street 1:301 MAPLE AVE W
Mailing Address - Street 2:BUILDING 3 STE F6
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4301
Mailing Address - Country:US
Mailing Address - Phone:703-281-1108
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE W
Practice Address - Street 2:BUILDING 3 STE F6
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4301
Practice Address - Country:US
Practice Address - Phone:703-281-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000833261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU02873Medicare UPIN
VA480000262Medicare Oscar/Certification
C02723Medicare PIN
SVA633Medicare PIN