Provider Demographics
NPI:1306992961
Name:GLENN H FUCHS MD PC
Entity type:Organization
Organization Name:GLENN H FUCHS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-578-1770
Mailing Address - Street 1:6565 ARLINGTON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3000
Mailing Address - Country:US
Mailing Address - Phone:703-578-1770
Mailing Address - Fax:703-820-7088
Practice Address - Street 1:6565 ARLINGTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3000
Practice Address - Country:US
Practice Address - Phone:703-578-1770
Practice Address - Fax:703-820-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12067207N00000X
VA0101033724207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
814870OtherAETNA
503527OtherNCPPO
VA060386OtherBLUE SHIELD
DC1546OtherBCBS
503527OtherNCPPO
070853Medicare ID - Type Unspecified
VA060386OtherBLUE SHIELD