Provider Demographics
NPI:1538362504
Name:FAIRFAX NEONATAL ASSOCIATES, PC
Entity type:Organization
Organization Name:FAIRFAX NEONATAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-289-1448
Mailing Address - Street 1:2730 PROSPERITY AVE # B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2730 PROSPERITY AVE STE A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4330
Practice Address - Country:US
Practice Address - Phone:703-289-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRFAX NEONATAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty