Outpatient Services:

Allergy, Asthma and Immunology

Pediatric Specialists of VirginiaPhone: 703.976.788 Fax: 571.405.5720 Darlene Mansoor, MD

Allergy and Asthma CenterPhone: 703.729.8933 Fax: 703.729.5996 ☐ Anita Wasan, MD

Allergy, Asthma & Sinus Center Phone: 703.726.9720 Fax: 703.726.9721☐ Saba Sharif, MD

Allergy Partners of SpringfieldPhone: 703.323.3930 Fax:703.323.7457 ☐ Ananth Thyagarajan, MD

ENT & Allergy Specialists of Virginia Phone: 703.723.8727 Fax: 703.723.8722☐ Vickie Lee, MD

Fairfax Allergy, Asthma & Sinus ClinicPhone: 703.648.0030 Fax: 703.648.9028 ☐ Derek Johnson, MD

☐ Claus Helbing, MDPhone: 703.750.9450 Fax: 703.750.3191

☐ Mehdi Bajoghli, MDPhone: 703.490.5803 Fax: 703.490.6443

☐ Donna Felberbaum - Schuster, MDPhone: 703.689.2000 Fax: 703.478.6612

☐ Manuel Guillen, MDPhone: 703 757.7950 Fax: 703 757.7953

☐ Larry A. Miller, MDPhone: 703.938.5660 Fax: 703.242.8712

☐ Anne Miranowski, MDPhone: 703.289.1410 Fax: 703.289.1420

☐ Srinagesh Paluvoi, MDPhone: 703.538.5110 Fax: 703.538.5112

☐ John Simpson, MDPhone: 703.534.5500 Fax: 703.543.4838

☐ Lan Tu, MDPhone: 703.237.2488 Fax: 703.237.2492

Audiology

Advanced Hearing ServicesPhone: 703.573.7606 Fax: 703.560.3808 ☐ Douglas Briethaupt, MS, CCC-A ☐ Sarah Garrison, AuD, CCC-A ☐ Carol Hudner, CCC-A, FAAA ☐ Kelly Roma, AuD, FAAA ☐ Christine Sofie, AuD, CCC-A, FAAA

ENT & Allergy Specialists of VirginiaPhone: 703.723.8727 Fax: 703.723.8722 ☐ Olivia Henson, AuD

Fairfax Hearing CenterPhone: 703.573.4327 Fax: 703.698.1334☐ Karen Friedner, AuD, CCC-A

Pediatrix Audiology ServicesPhone: 703.776.4296 Fax: 954.337.2784 ☐ L. Ashleigh Greenwood, AuD, CCC-A ☐ Susan Steinburg, AuD ☐ Heather Strang, AuD, CCC-A

Professional Hearing ServicesPhone: 703.536.1666 Fax: 703.536.5337☐ Kenneth Henry, PhD, CCC-A ☐ Kathryn Rios, AuD, CCC-A

The Hearing Center at Advanced ENT SpecialistsPhone: 703.858.5885 Fax: 703.858.5001 ☐ Kimberly Johnson, AuD, CCC-A

Virginia Head and Neck Surgery Phone: 703.858.4439 Fax: 703.858.4489☐ Kathryn Stover, AuD, CCC-A

Cardiac Electrophysiology

Inova Medical Group, ArrhythmiaPhone: 703.289.9400 Fax: 703.289.9404 ☐ Ted Friehling, MD

Cardiac Surgery

Cardiac Vascular & Thoracic Surgery Associates, P.C.Phone: 703.280.5858 Fax: 703.849.0874☐ Lucas Collazo, MD

Cardiology

Child Cardiology AssociatesPhone: 703.876.8410 Fax: 703.876.8417 ☐ Patrick Callahan, MD ☐ Steven Herold, MD ☐ Jared Hershenson, MD ☐ William Kirby, MD ☐ Jennifer Lindsey, MD

Children’s Heart AssociatesPhone: 571.292.9940 Fax: 703.335.9531 ☐ Mohamed Mardini, MD

Children’s Heart InstitutePhone: 866.645.4055 Fax: 703.392.9464 ☐ Hasan Abdallah, MD ☐ Robert Barlow, MD ☐ Amir Dangol, MD☐ Georgios Hartas, MD☐ Kalpana Thammineni, MD

The Healthy Heart Clinic Phone: 703.485.0470 Fax: 703.986.0825 ☐ Wali Gauvin, MD

Pediatric Cardiology AssociatesPhone: 703.573.0504 Fax: 703.573.4856 ☐ Annette Ansong, MD ☐ Alan Benheim, MD ☐ Robert Escalera, MD

Cochlear Implants

Otolaryngology AssociatesPhone: 703.383.8130 Fax: 703.383.7350☐ Jerry Lin, MD

Craniofacial Disorders

Inova Craniofacial Program Phone: 703.776.6920 ☐ Stephen Baker, MD☐ Chris Chang, MD☐ Craig DuFresne, MD☐ Marsha Renee Jesperson, MD☐ Leon Moores, MD

Dentistry

Golden Dental Associates, PCPhone: 703.640.1000 Fax: 703.630.2526 ☐ Alan Golden, DDS

Little PearlsPhone: 703.726.3030 Fax: 703.726.5221 ☐ Michael Gazori, DDS

☐ Faranak Ghalehbaghi, DDS Phone: 703.352.4121 Fax: 703.352.4122

☐ April Joy Johnson Toyer, DDSPhone: (703) 497.1234 Fax: (703) 499.9988

☐ Robert Sears, DDS Phone: 703.707.2070 Fax: 703.707.0450

☐ Shohreh Sharif, DDS Phone: 703.620.9122 Fax: 703.620.6033

☐ Jack Weil, DMD Phone: 703.255.2573 Fax: 703.255.2278

Dermatology ☐ Ho Jin Kim, MD Phone: 703.893.3710 Fax: 703.734.1404

☐ Robert Silverman, MD Phone: 703.641.0083 Fax: 703.641.0085

Developmental Pediatrics

Pediatric Specialists of VirginiaPhone: 703.876.2788 Fax: 571.405.5720☐ Jacquelyn Calbert, MD☐ Shalinee Khurana, MD

☐ Polly Panitz, MD Phone: 703.860.4200 Fax: 703.860.1528

Endocrinology

Pediatric Specialists of Virginia Phone: 703.876.2788 Fax: 703.839.8760 ☐ Oksana Lazareva, MD ☐ Kathleen Link, MD ☐ Rinku Mehra, MD

Georgetown University Medical CenterPhone: 202.444.8881 Fax: 202.444.7161 ☐ Douglas Sobel, MD

Gastroenterology

Pediatric Specialists of VirginiaPhone: 703.876.2788 Fax: 703.839.8760 ☐ Catherine Chao, MD ☐ Lynn Duffy, MD☐ Stefany Honigbaum, MD ☐ Suchitra Hourigan, MD ☐ Muhammad Khan, MD ☐ Peter Lee, MD

Pediatric Gastroenterology of Northern Virginia Phone 571. 314.0444 Fax: 855.237.3628 ☐ Benjamin Enav, MD

General Surgery

Pediatric Surgical Group A division of Fairfax Neonatal AssociatesPhone: 703.560.2236 Fax: 703.876.4960 ☐ Joseph Hartwich, MD ☐ Stephen Kim, MD ☐ Alexander Soutter, MD

Genetics

Pediatric Specialists of VirginiaPhone: 703.876.2788 Fax: 703.970.2620☐ Carlos Ferreira, MD☐ Eyby Leon, MD ☐ Debra Regier, MD☐ Pranoot Tanpaiboon, MD

☐ Louay Toni, MD

Inova Children’s Hospital

Patient Name: Date of Birth:

Home Phone: Work Phone: Mobile Phone:

Referring Physician: Signature:

Referring Physician Phone: Referring Physician Fax:

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Specialists Referral Form

Continued on back page>>

inovachildrens.org

This star indicates that physicians are employed by Inova Children’s Hospital or Pediatric Specialists of Virginia.

☐ Jennifer O’Neil, MD ☐ Harish Rudra, DO ☐ Christopher Talluto, MD ☐ James Thompson, MD

☐ Ian Leibowitz, MD ☐ Otto Louis-Jacques, MD ☐ Natalie Sikka, MD ☐ Jaime Wolfe, MD ☐ Sharon Karr, MD

☐ Jin Park, MD ☐ Sherif Tawfik, MD

☐ Otilia Neacsu, MD ☐ Mia Pingul, MD ☐ Priya Vaidyanathan, MD

☐ Marcelo Cardarelli, MD

Hematology/Oncology

Pediatric Specialists of Virginia Phone: 703.876.2788 Fax: 703.531.1590 ☐ Jennifer Dean, MD ☐ Robin Dulman, MD ☐ Christopher Lawlor, MD ☐ Niccole Piguet, MD

Infectious Diseases

Inova Medical Group - Children’s Infectious Disease Phone: 703.776.6041 Fax: 703.776.4098 ☐ David P. Ascher, MD

Pediatric Specialists of Virginia Phone: 703.876.2788 Fax: 703.839.8761 ☐ Daniel Keim, MD ☐ Rebecca Levorson, MD ☐ Andrew Nuibe, MD

Nephrology

Pediatric Specialists of VirginiaPhone: 703.876.2788 Fax: 703.839.8760 ☐ Rasheda Amin, MD☐ Robert Fildes, MD ☐ Randala Lakkis, MD

Neurology

Pediatric Specialists of Virginia Phone: 703.876.2788 Fax: 571.405.5720 ☐ Taeun Chang, MD☐ Lucy Civitello, MD ☐ Emily Frelich, MD ☐ Tarannum Lateef, MD ☐ Raquel Langdon, MD

Neurosurgery

Pediatric Specialists of VirginiaPhone: 703.876.2788 Fax: 703.970.0240 ☐ Leon Moores, MD

Children’s Outpatient Center of Northern VirginiaPhone: 571.226.8380 Fax: 571.226.8362 ☐ John Myseros, MD

Neuropsychology

☐ Ida Sue Baron, PhD, ABPP-CN Phone: 703.752.2757 Fax: 301.340.2119

Nutrition

Nutritional Healing Phone: 703.504.8702 ☐ Michelle Berman, MS, RD

Ophthalmology

Eye Consultants of Northern Virginia, PC Phone: 703.451.6111 Fax: 703.451.6247 ☐ Edward Parelhoff, MD

Northern Virginia Ophthalmology Associates, PCPhone: 703.534.3900 Fax: 703.536.3729 ☐ Forrest Ellis, MD ☐ Amy Jeffery, MD ☐ David Seidman, MD

Northern Virginia Vision Center Phone: 703.430.4400 Fax: 703.430.4130 ☐ Tina Butera, MD, AAPOS

☐ Steven Bullard, MD Phone: 703.370.2455 Fax: 703.641.4841

☐ Lisa Wei, MD Phone: 703.528.8899 Fax: 703.528.5688

Orthopedic Surgery and Sports Medicine

Inova Medical Group - Orthopaedics and Sports MedicinePhone: 703.205.2626 Fax: 703.205.2630☐ Peter McArthur, MD ☐ Robert Najarian, MD ☐ Mark Theiss, MD

OrthoVirginiaPhone: 703.810.5228 Fax: 703.810.5318 ☐ Amy Henning, DO ☐ Candice Holden, MD ☐ Kathleen McHale, MD

Pediatric Specialists of Virginia Phone: 703.876.2788 Fax: 571.405.5720☐ Kaleb Friend, MD☐ George Gantsoudes, MD☐ Jeffrey Hanway, MD

Orthopedics - Musculoskeletal Tumors

☐ Felasfa Wodajo, MD Phone: 703.280.5390 Fax: 703.280.9596

Otolaryngology

Advanced ENT SpecialistsPhone: 703.858.5885 Fax: 703.858.5001☐ Mahesh Parameswaran, MD

Ear, Nose and Throat Specialists of NoVAPhone: 703.536.2729 Fax: 703.241.0381☐ Richard Gardner, MD ☐ Josef Gurian, MD☐ Joshua Oppenheim, MD

ENT & Allergy Specialists of Virginia Phone: 703.723.8727 Fax: 703.723.8722☐ James Lee, MD

Fairfax ENT & Facial Plastic SurgeryPhone: 703.534.3314 Fax: 703.698.1334☐ Timothy Egan, MD ☐ Laurence O’Halloran, MD

Northern Virginia ENT Associates Phone: 703.729.8080 Fax: 703.729.1914☐ Michael Mellis, MD

Otolaryngology Associates, PCPhone: 703. 383.8130 Fax: 703.383.7350 ☐ Robert Bahadori, MD ☐ Deborah Doyle, MD ☐ Patty Lee, MD ☐ Jerry Lin, MD☐ Bryan A. McKenzie, MD☐ Belinda Mantle, MD

Virginia Head and Neck Surgery Phone: 703.858.4439 Fax: 703.858.4489 ☐ Andrew Silva, MD ☐ Lisa A. Fox, MD

Otology

☐ Theodore Fetter, MDPhone: 703.356.1465 Fax: 301.654.9727

Pediatric and Adolescent Gynecology

Pediatric Specialists of Virginia Phone: 703.876.2788☐ Rachel Casey, MD

Physical Medicine and Rehabilitation

Pediatric Specialists of VirginiaPhone: 703.876.2788 Fax: 202.444.2130☐ Olga Morozova, MD

Plastic Surgery

Inova Craniofacial Program Phone: 703.776.6920 ☐ Stephen Baker, MD ☐ Chris Chang, MD☐ Craig DuFresne, MD☐ Marsha Renee Jesperson, MD

Psychiatry/Psychology

Inova Kellar CenterPhone: 703.218.8500 Fax: 703.359.0463 ☐ Lorency Fernando, MD ☐ Sonali Rohit Mahajan, MD ☐ Stephanie Mayrant, MD

George Mason University Center for Psychological Services Phone: 703.993.1370 Fax: 703.352.0035 ☐ Robyn Mehlenbeck, PhD ☐ Dawna Thompson, PhD

☐ Gordon Gondos, MDPhone: 703.821.1317 Fax: 703.821.0436

Northern Virginia Psychiatric GroupPhone: 703.698.5220 Fax: 703.573.2351 ☐ James McMurrer, MD

Psychiatric Assessment Center Phone: 571.623.3500 Fax: 703.204.9001☐ Marc Dalton, MD ☐ Afia Hussain, MD

Pulmonology

The Pediatric Lung Center A division of Fairfax Neonatal AssociatesPhone: 703.289.1410 Fax: 703.289.1420 ☐ James Clayton, MD ☐ Sunil Kapoor, MD

Rheumatology

Pediatric Specialists of Virginia Phone: 703.876.2788 Fax: 703.839.8760 ☐ Bita Arabshahi, MD ☐ Tova Ronis, MD ☐ Emily Way, MD

Sleep Medicine

The Pediatric Sleep Center A division of Fairfax Neonatal AssociatesPhone: 540.751.1955 Fax: 540.751.1954 ☐ Suraiya Haider, MD ☐ Aarthi Vemana, MD ☐ Glenna Winnie, MD

Scoliosis and Spine Surgery

Inova Medical Group - NeurosurgeryPhone: 703.970.2670☐ Brian McHugh, MD

Pediatric Specialists of Virginia Phone: 703.970.2600 Fax: 703.970.2620 ☐ Jeffrey Hanway, MD

OrthoVirginiaPhone: 703.810.5228 Fax: 703.810.5318☐ Amy Henning, DO ☐ Kathleen McHale, MD

Urology

Children’s National Specialists of Virginia, LLCPhone: 571.766.3100 Fax: 703.766.3091 ☐ M. David Gibbons, MD ☐ Hans Pohl, MD

inovachildrens.org

Revised: 1/2016

G34533/1-16/25s-400 pads

For more information on our childrens’ specialties or to find a physician, visit inovachildrens.org

☐ Ryan Murray, MD☐ Vicki Owczarzak, MD ☐ Mark Rubinstein, MD ☐ Mark Soltany, MD☐ Allison B.J Tobey, MD

☐ Shruti Tewari, MD ☐ Sonia Thomas, MD

☐ Bennett Lavenstein, MD ☐ William McClintock, MD ☐ John Schreiber, MD ☐ Thuy-Anh Vu, MD ☐ Terry Watkin, MD

☐ Jessica Wertz, DO ☐ Robin West, MD

☐ Davoud Mohtat, MD ☐ Patricia Seo-Mayer, MD

This star indicates that physicians are employed by Inova Children’s Hospital or Pediatric Specialists of Virginia.

☐ Emily Hattwick, MD☐ Benjamin Martin, MD ☐ Suzanne Walters, MD

☐ Sadhna Shankar, MD ☐ Marshall Schorin, MD ☐ Carly Varela, MD ☐ Elizabeth Yang, MD