# CENTER FOR PRIMARY CARE & GERIATRICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902973423
- **Authorized official:** DR. CISSY PAUL POTTANAT MD MPH (OWNER PRESIDENT)
- **Authorized official phone:** (703) 532-9411

## Contact information

- **Practice address:** 7115 LEESBURG PIKE STE 211, FALLS CHURCH, VA 22043-2301
- **Practice address phone:** (703) 532-1111
- **Practice address fax:** (703) 532-3224
- **Mailing address:** 6319 CASTLE PLACE, SUITE \#3D, FALLS CHURCH, VA 22044-1907
- **Mailing address phone:** (703) 532-1111
- **Mailing address fax:** (703) 532-3224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101056325 | VA | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 05/28/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 287222 | ANTHEM | — |
| 01 | — | 49D0222254 | CLIA \# | — |
| 05 | — | 5628997 | — | VA |
| 01 | — | F383001 | CAREFIRST | — |