Organization
CENTER FOR PRIMARY CARE & GERIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CISSY PAUL POTTANAT MD MPH (OWNER PRESIDENT)
(703) 532-9411
Entity
Organization
Contact information
Practice address
7115 LEESBURG PIKE STE 211, FALLS CHURCH, VA 22043-2301
(703) 532-1111
(703) 532-3224
Mailing address
6319 CASTLE PLACE, SUITE #3D, FALLS CHURCH, VA 22044-1907
(703) 532-1111
(703) 532-3224
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101056325
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
287222
ANTHEM
—
01
—
49D0222254
CLIA #
—
05
—
5628997
—
VA
01
—
F383001
CAREFIRST
—
Enumeration date
11/29/2006
Last updated
05/28/2023
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