| Fairfaxmd, Pllc | |
|
10721 Main St Suite 3300 Fairfax VA 22030-6908 | |
| (703) 229-4455 | |
| (703) 229-4454 |
| Full Name | Fairfaxmd, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10721 Main St, Fairfax, Virginia |
| Authorized Official Name and Position | Richard W Chen (MANAGING MEMBER) |
| Authorized Official Contact | 7032294455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairfaxmd, Pllc 10721 Main St Suite 3300 Fairfax VA 22030-6908 Ph: (703) 229-4455 | Fairfaxmd, Pllc 10721 Main St Suite 3300 Fairfax VA 22030-6908 Ph: (703) 229-4455 |
| NPI Number | 1437468311 |
|---|---|
| Provider Enumeration Date | 09/27/2010 |
| Last Update Date | 01/28/2015 |
| Medicare PECOS PAC ID | 4880882786 |
|---|---|
| Medicare Enrollment ID | O20101220000297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437468311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard W Chen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386652147 PECOS PAC ID: 3577538966 Enrollment ID: I20040830000444 |
| Provider Name | Cecilia T. Young |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588633705 PECOS PAC ID: 9436284973 Enrollment ID: I20100323000107 |
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