Basic Information
| Provider Information | |||||||||
| NPI: | 1366744062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INOVA FAIRFAX HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 ALA MOANA BLVD | ||||||||
| Address2: | APARTMENT 2806 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968151427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499339538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220423307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037764001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF TRANSPLANT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7047762907 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.