Organization
FAIRFAX MEDICAL LABORATORIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT FREDERICKS (VICE PRESIDENT)
(703) 222-2313
Entity
Organization
Contact information
Practice address
4200 PLEASANT VALLEY RD, CHANTILLY, VA 20151-1211
(703) 222-2313
(703) 263-2582
Mailing address
4200 PLEASANT VALLEY RD, CHANTILLY, VA 20151-1211
(703) 222-2313
(703) 263-2582
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
49D0221827
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004980760
—
VA
05
—
0062430
—
VA
05
—
31230500
—
DC
05
—
38779000
—
WV
05
—
431418200
—
MD
01
—
690001517
RAILROAD MEDICARE
—
Enumeration date
06/25/2006
Last updated
01/10/2013
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