Provider Demographics
NPI:1821055609
Name:FAIRFAX NEONATAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:FAIRFAX NEONATAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BENGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-289-1422
Mailing Address - Street 1:3060 WILLIAMS DRIVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4648
Mailing Address - Country:US
Mailing Address - Phone:703-289-1400
Mailing Address - Fax:703-289-1414
Practice Address - Street 1:3060 WILLIAMS DRIVE
Practice Address - Street 2:SUITE 520
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4648
Practice Address - Country:US
Practice Address - Phone:703-289-1400
Practice Address - Fax:703-289-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty