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Chisovereign Pllc
Medical Specialty Clinic/Center in Fairfax, Virginia
NPI 1225454291

Chisovereign Pllc is a Medical Specialty Clinic/Center based in Fairfax, VA and is specialized in Medical Specialty. Chisovereign Pllc practices in Fairfax, VA. The NPI Number for Chisovereign Pllc is 1225454291 and holds a License No. 0101246435 (Virginia).

The current practice location address for Chisovereign Pllc is 3975 Fair Ridge Dr, Fairfax, VA and can be reached out via phone at 703-246-0011 and via fax at 703-246-0012.

Location: 3975 Fair Ridge Dr, Fairfax, VA, 22033-2911
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1225454291
Provider Name
Chisovereign Pllc
Credential
Provider Entity Type
Organization
Address
3975 Fair Ridge Dr, Fairfax, VA, 22033-2911
Phone Number
703-246-0011
Fax Number
703-246-0012
Provider Enumeration Date
03/13/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3975 Fair Ridge Dr
City
Fairfax
State
Virginia
Zip
22033-2911
Phone Number
703-246-0011
Fax Number
703-246-0012
person
Provider Business Mailing Address Details
Address
3975 Fair Ridge Dr
City
Fairfax
State
Virginia
Zip
22033-2911
Phone Number
703-246-0011
Fax Number
703-246-0012
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
0101246435 (Virginia)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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