Provider Demographics
NPI:1427324722
Name:FAIR OAKS SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:FAIR OAKS SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL NOUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-391-3620
Mailing Address - Street 1:PO BOX 221135
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-1135
Mailing Address - Country:US
Mailing Address - Phone:703-391-3620
Mailing Address - Fax:703-391-3713
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 408
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1745
Practice Address - Country:US
Practice Address - Phone:703-391-3620
Practice Address - Fax:703-391-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty