Provider Demographics
NPI:1871762849
Name:FAIRFAX FAMILY PRACTICE CENTERS PC
Entity type:Organization
Organization Name:FAIRFAX FAMILY PRACTICE CENTERS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-255-9100
Mailing Address - Street 1:22895 BRAMBLETON PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148
Mailing Address - Country:US
Mailing Address - Phone:703-726-0003
Mailing Address - Fax:703-726-6444
Practice Address - Street 1:22895 BRAMBLETON PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148
Practice Address - Country:US
Practice Address - Phone:703-726-0003
Practice Address - Fax:703-726-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06907Medicare PIN