Fairfax Medical Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

FAIRFAX MEDICAL LAB LLC

Practice address

4221 Walney Rd Ste 401a
Chantilly, VA 20151-2987

Phone

(571) 577-5556

NPI assigned

Jul 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Asra Rahman, CEO

Title

Owner

Phone

(571) 577-5556

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1205445491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 WALNEY RD STE 401A",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512987",
            "telephone_number": "571-577-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 WALNEY RD STE 401A",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201512987",
            "telephone_number": "571-577-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX MEDICAL LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-09-09",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "ASRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-577-5556",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.