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General NPI Number Information
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NPI Number | 1669978300
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Entity Type | Organization
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Legal Business Name | PRIME CARE PHYSICIANS LLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 6299 LEESBURG PIKE STE C
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2101
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Country | US
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Telephone | 571-216-9984
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Fax |
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Provider Business Mailing Address
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Address Line | 4666 KELL LN
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City | ALEXANDRIA
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State | VA
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Zip | 22311-4918
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Country | US
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Telephone | 571-216-9984
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL DIRECTOR
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Name | DEREJE LEGESSE
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Credential | MD
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Telephone | 571-216-9984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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