Provider Demographics
NPI:1922540715
Name:FAIRFAX URGENT CARE GROUP
Entity Type:Organization
Organization Name:FAIRFAX URGENT CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSRAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-665-4001
Mailing Address - Street 1:332 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4818
Mailing Address - Country:US
Mailing Address - Phone:571-665-4001
Mailing Address - Fax:
Practice Address - Street 1:332 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4818
Practice Address - Country:US
Practice Address - Phone:571-665-4001
Practice Address - Fax:571-665-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care