Provider Demographics
NPI:1396026530
Name:FERNANDEZ-BUENO, CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ-BUENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2625
Mailing Address - Country:US
Mailing Address - Phone:703-641-0100
Mailing Address - Fax:703-658-0711
Practice Address - Street 1:7619 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 900
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2625
Practice Address - Country:US
Practice Address - Phone:703-641-0100
Practice Address - Fax:703-658-0711
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery