Provider Demographics
NPI:1487942793
Name:LORTON PRIMARY CARE PLC
Entity type:Organization
Organization Name:LORTON PRIMARY CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAKONNEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZELLEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-339-5858
Mailing Address - Street 1:7740 GUNSTON PLZ
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1897
Mailing Address - Country:US
Mailing Address - Phone:703-339-5858
Mailing Address - Fax:703-339-5860
Practice Address - Street 1:7740 GUNSTON PLZ
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1897
Practice Address - Country:US
Practice Address - Phone:703-339-5858
Practice Address - Fax:703-339-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty