Healthcare Provider Details

I. General information

NPI: 1063740199
Provider Name (Legal Business Name): NEW FLOWER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SOUTH PICKETT ST
ALEXANDRIA VA
22304
US

IV. Provider business mailing address

8439 LAKE MIST WAY
FAIRFAX STATION VA
22039-2676
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-2300
  • Fax:
Mailing address:
  • Phone: 703-646-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0101055711
License Number StateVA

VIII. Authorized Official

Name: MELAKU AYALEW
Title or Position: CEO
Credential: M.D.
Phone: 703-200-5422