National Provider Identifier Database

FAIRFAX ENT FACIAL PLASTIC SURGERY PC
Plastic Surgery within the Head & Neck

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.


Contact Information

FAIRFAX ENT & FACIAL PLASTIC SURGERY, PC
8120 GATEHOUSE RD
#3
FALLS CHURCH, VA22042-1204
Phone: 703-573-3687
Fax: 703-204-0114
Website:
Specialty Taxonomy Code
* Plastic Surgery within the Head & Neck 207YX0007X

* Indicates primary specialty

NPI Profile & details for FAIRFAX ENT & FACIAL PLASTIC SURGERY, PC

NPI Number 1720259054
Legal business name
LBN
FAIRFAX ENT & FACIAL PLASTIC SURGERY, PC
Authorized official LAURENCE O'HALLORAN - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 03/14/2008
Last updated 06/15/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • VA License #: 0101051134

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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