# FAIRFAX NEONATAL ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fairfax Neonatal Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821055609
- **Authorized official:** MR. GREGORY EDWARD BENGSTON (EVP, COO)
- **Authorized official phone:** (703) 289-1422

## Contact information

- **Practice address:** 3060 WILLIAMS DRIVE, SUITE 520, FAIRFAX, VA 22031-4648
- **Practice address phone:** (703) 289-1400
- **Practice address fax:** (703) 289-1414
- **Mailing address:** 3060 WILLIAMS DRIVE, SUITE 520, FAIRFAX, VA 22031-4648
- **Mailing address phone:** (703) 289-1400
- **Mailing address fax:** (703) 289-1414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | Yes |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | Yes |
| 2080P0214X | Pediatric Pulmonology Physician | — | NULL | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | — | — |

## Other

- **Enumeration date:** 04/27/2006
- **Last updated:** 05/21/2025