Organization
LORTON PRIMARY CARE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAKONNEN K ZELLEKE M.D. (PRESIDENT/CEO)
(703) 339-5858
Entity
Organization
Contact information
Practice address
7740 GUNSTON PLZ, LORTON, VA 22079-1897
(703) 339-5858
(703) 339-5860
Mailing address
7740 GUNSTON PLZ, LORTON, VA 22079-1897
(703) 339-5858
(703) 339-5860
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
07/20/2011
Last updated
07/20/2011
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