Provider Demographics
NPI:1912900598
Name:PFUNDSTEIN, JOANN (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:PFUNDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER COURT
Mailing Address - Street 2:SUITE B102
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2220
Mailing Address - Country:US
Mailing Address - Phone:571-327-5107
Mailing Address - Fax:571-327-5786
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE B102
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:571-327-5107
Practice Address - Fax:571-327-5786
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5873576Medicaid
A582-0003OtherBCBS PLANS
A582-0003OtherBCBS PLANS
005818A64Medicare ID - Type UnspecifiedTRAILBLAZER MEDICARE
281185OtherMDIPA/ALLIANCE PPO PLANS
5842002OtherAETNA HEALTHCARE PLANS
VA5873576Medicaid
503959OtherNCPPO
440003138Medicare ID - Type UnspecifiedRAILROAD MEDICARE