| Generations Family Practice | |
|
12040 S Lakes Dr Ste 190 Reston VA 20191-1246 | |
| (703) 464-0686 | |
| (703) 464-0698 |
| Full Name | Generations Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 12040 S Lakes Dr, Reston, Virginia |
| Authorized Official Name and Position | Kevin John Kelleher (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7034640686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Generations Family Practice 12040 S Lakes Dr Suite 207 Reston VA 20191-1246 Ph: (703) 464-0686 | Generations Family Practice 12040 S Lakes Dr Ste 190 Reston VA 20191-1246 Ph: (703) 464-0686 |
| NPI Number | 1124239470 |
|---|---|
| Provider Enumeration Date | 05/25/2007 |
| Last Update Date | 01/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124239470 | NPI | - | NPPES |
| G00463 | Other | MEDICARE GROUP NO. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101054571 (Virginia) | Primary |
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