MEDICARE: PRIME CARE PHYSICIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1669978300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	4666 KELL LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-4918
Country	:	US
Telephone Number	:	571-216-9984
Fax Number	:

Provider Business Practice Location Address
First Line	:	6299 LEESBURG PIKE STE C
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2101
Country	:	US
Telephone Number	:	571-216-9984
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL DIRECTOR
Name	:	DEREJE LEGESSE
Credential	:	MD
Telephone Number	:	571-216-9984

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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Directions to “PRIME CARE PHYSICIANS LLC ” Practice Location

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