| Heritage Family Practice Associates, P.c. | |
|
4001 Fair Ridge Dr #101 Fairfax VA 22033-2917 | |
| (703) 385-6789 | |
| (703) 352-9409 |
| Full Name | Heritage Family Practice Associates, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4001 Fair Ridge Dr, Fairfax, Virginia |
| Authorized Official Name and Position | James Overton (OFFICE MANAGER) |
| Authorized Official Contact | 7033856789 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Family Practice Associates, P.c. 4001 Fair Ridge Dr #101 Fairfax VA 22033-2917 Ph: (703) 385-6789 | Heritage Family Practice Associates, P.c. 4001 Fair Ridge Dr #101 Fairfax VA 22033-2917 Ph: (703) 385-6789 |
| NPI Number | 1881765279 |
|---|---|
| Provider Enumeration Date | 11/10/2006 |
| Last Update Date | 04/09/2014 |
| Medicare PECOS PAC ID | 5294765210 |
|---|---|
| Medicare Enrollment ID | O20050818000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881765279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0645748 (Virginia) | Primary |
| Provider Name | Marie Christine Fugitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073891529 PECOS PAC ID: 9234366014 Enrollment ID: I20131227000068 |
| Provider Name | Jee Eun Lee Karl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598070732 PECOS PAC ID: 2264620988 Enrollment ID: I20150616000147 |
| Provider Name | Jeffrey Conklin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265513238 PECOS PAC ID: 1153328448 Enrollment ID: I20150616001987 |
| Provider Name | Jean Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144477894 PECOS PAC ID: 4587962352 Enrollment ID: I20160411002151 |
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