Provider Demographics
NPI:1649437666
Name:INOVA FAIRFAX HOSPITAL FOR CHILDREN
Entity type:Organization
Organization Name:INOVA FAIRFAX HOSPITAL FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRISELDA
Authorized Official - Middle Name:MANI
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-259-2100
Mailing Address - Street 1:3254 APPLEGATE CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1108
Mailing Address - Country:US
Mailing Address - Phone:832-259-2100
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:832-259-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019566282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren