Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101028232 | VA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101028232 | VA |
NPI | 1063401214 |
---|---|
Provider Name | Brent R Ain |
First Address | Fairfax, VA 22033-1710 |
Second Address | Fairfax, VA 22033-1710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 04/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B92973 | (02) |