| Lorton Primary Care PLC | |
|
7740 Gunston Plz Lorton VA 22079-1897 | |
| (703) 339-5858 | |
| (703) 339-5860 |
| Full Name | Lorton Primary Care PLC |
|---|---|
| Speciality | Pediatrics |
| Location | 7740 Gunston Plz, Lorton, Virginia |
| Authorized Official Name and Position | Makonnen K Zelleke (PRESIDENT/CEO) |
| Authorized Official Contact | 7033395858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lorton Primary Care PLC 7740 Gunston Plz Lorton VA 22079-1897 Ph: (703) 339-5858 | Lorton Primary Care PLC 7740 Gunston Plz Lorton VA 22079-1897 Ph: (703) 339-5858 |
| NPI Number | 1487942793 |
|---|---|
| Provider Enumeration Date | 07/20/2011 |
| Last Update Date | 07/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487942793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Secondary |
| 208000000X | Pediatrics | () | Primary |
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