Outpatient Services: Allergy, Asthma and Immunology Pediatric Specialists of Virginia Phone: 703.976.788 Fax: 571.405.5720 Darlene Mansoor, MD Allergy and Asthma Center Phone: 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 Springfield Phone: 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 Clinic Phone: 703.648.0030 Fax: 703.648.9028 ☐ Derek Johnson, MD ☐ Claus Helbing, MD Phone: 703.750.9450 Fax: 703.750.3191 ☐ Mehdi Bajoghli, MD Phone: 703.490.5803 Fax: 703.490.6443 ☐ Donna Felberbaum - Schuster, MD Phone: 703.689.2000 Fax: 703.478.6612 ☐ Manuel Guillen, MD Phone: 703 757.7950 Fax: 703 757.7953 ☐ Larry A. Miller, MD Phone: 703.938.5660 Fax: 703.242.8712 ☐ Anne Miranowski, MD Phone: 703.289.1410 Fax: 703.289.1420 ☐ Srinagesh Paluvoi, MD Phone: 703.538.5110 Fax: 703.538.5112 ☐ John Simpson, MD Phone: 703.534.5500 Fax: 703.543.4838 ☐ Lan Tu, MD Phone: 703.237.2488 Fax: 703.237.2492 Audiology Advanced Hearing Services Phone: 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 Virginia Phone: 703.723.8727 Fax: 703.723.8722 ☐ Olivia Henson, AuD Fairfax Hearing Center Phone: 703.573.4327 Fax: 703.698.1334 ☐ Karen Friedner, AuD, CCC-A Pediatrix Audiology Services Phone: 703.776.4296 Fax: 954.337.2784 ☐ L. Ashleigh Greenwood, AuD, CCC-A ☐ Susan Steinburg, AuD ☐ Heather Strang, AuD, CCC-A Professional Hearing Services Phone: 703.536.1666 Fax: 703.536.5337 ☐ Kenneth Henry, PhD, CCC-A ☐ Kathryn Rios, AuD, CCC-A The Hearing Center at Advanced ENT Specialists Phone: 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, Arrhythmia Phone: 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 Associates Phone: 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 Associates Phone: 571.292.9940 Fax: 703.335.9531 ☐ Mohamed Mardini, MD Children’s Heart Institute Phone: 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 Associates Phone: 703.573.0504 Fax: 703.573.4856 ☐ Annette Ansong, MD ☐ Alan Benheim, MD ☐ Robert Escalera, MD Cochlear Implants Otolaryngology Associates Phone: 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, PC Phone: 703.640.1000 Fax: 703.630.2526 ☐ Alan Golden, DDS Little Pearls Phone: 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, DDS Phone: (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 Virginia Phone: 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 Center Phone: 202.444.8881 Fax: 202.444.7161 ☐ Douglas Sobel, MD Gastroenterology Pediatric Specialists of Virginia Phone: 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 Associates Phone: 703.560.2236 Fax: 703.876.4960 ☐ Joseph Hartwich, MD ☐ Stephen Kim, MD ☐ Alexander Soutter, MD Genetics Pediatric Specialists of Virginia Phone: 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: Known / Suspected Diagnosis: Symptoms / Concerns: 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