Provider Demographics
NPI:1063401214
Name:AIN, BRENT R (MD)
Entity type:Individual
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First Name:BRENT
Middle Name:R
Last Name:AIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1710
Mailing Address - Country:US
Mailing Address - Phone:703-391-0111
Mailing Address - Fax:703-391-2945
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-0111
Practice Address - Fax:703-391-2945
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-08-04
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Provider Licenses
StateLicense IDTaxonomies
VA0101028232207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC050694F32Medicare PIN
B92973Medicare UPIN