Provider Demographics
NPI:1124106455
Name:FAIRFAX ORTHOPAEDICS, PLLC
Entity type:Organization
Organization Name:FAIRFAX ORTHOPAEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFC MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-560-9495
Mailing Address - Street 1:3301 WOODBURN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 WOODBURN RD STE 208
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1200
Practice Address - Country:US
Practice Address - Phone:703-560-9495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01294Medicare ID - Type Unspecified
VAG00950Medicare ID - Type Unspecified
4569480001Medicare NSC