Phenom Surgical LLC

NPI #1871842989 in Fairfax, Virginia

Provider Information

NPI Number: 1871842989
Entity Type: Organization
Organization Name: Phenom Surgical LLC
Primary Specialty: Surgery
Enumeration Date: Sep 5, 2012
Last Updated: May 16, 2016

Practice Location

Address: 2750 PROSPERITY AVE
Address 2: #120
City: Fairfax
State: Virginia
ZIP Code: 22031-4312
Phone: (703) 659-4557

Authorized Official

Name: MR. THOMAS LAMONT HEGENS, LCSA
Title: OWNER/CEO
Phone: (703) 659-4557

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Surgery	208600000X	Primary

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