Organization
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.
Active
Other names
MTV Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN MD (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
9600 GODWIN DR, MANASSAS, VA 20110-4162
(703) 396-1067
(703) 396-1060
Mailing address
5500 MARYLAND WAY, BRENTWOOD, TN 37027-4948
(703) 396-1067
(703) 396-1060
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
03/29/2011
Last updated
08/15/2022
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