Provider Demographics
NPI:1649378035
Name:FOX, STEVEN G (PAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:FOX
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WELLFORD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3176
Mailing Address - Country:US
Mailing Address - Phone:540-361-1830
Mailing Address - Fax:
Practice Address - Street 1:2800 WELLFORD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3176
Practice Address - Country:US
Practice Address - Phone:540-361-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02375OtherMEDICARE GROUP
VA008951225Medicaid
VACA9037OtherMCR RAILROAD GROUP
VA0110840508OtherLICENSE
VAP86577Medicare UPIN
VAP00052232Medicare PIN
VA001276P29Medicare PIN