Organization
FAIRFAX UROLOGY ASSOCIATES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM LLOYD GLOVER JR. MD (CEO OWNER)
(703) 591-5443
Entity
Organization
Contact information
Practice address
10875 MAIN ST, SUITE 208, FAIRFAX, VA 22030-4732
(703) 591-5443
(703) 591-0486
Mailing address
10875 MAIN ST, SUITE 208, FAIRFAX, VA 22030-4732
(703) 591-5443
(703) 591-0486
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101022555
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010877
ANTHEM
VA
01
—
340013417
RR
VA
01
—
6488
CAREFIRST
VA
Enumeration date
09/26/2007
Last updated
06/10/2008
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