Provider Demographics
NPI:1588740161
Name:FAIRFAX FAMILY PRACTICE CENTERS, P.C
Entity type:Organization
Organization Name:FAIRFAX FAMILY PRACTICE CENTERS, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-255-9100
Mailing Address - Street 1:PO BOX 791128
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1128
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:8301 ARLINGTON BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2902
Practice Address - Country:US
Practice Address - Phone:703-698-9000
Practice Address - Fax:703-698-6901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRFAX FAMILY PRACTICE CENTERS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty