| Lighthouse Family Medicine And Wellness Pllc | |
|
19465 Deerfield Ave Ste 309 Lansdowne VA 20176-1705 | |
| (571) 293-2424 | |
| (972) 947-5370 |
| Full Name | Lighthouse Family Medicine And Wellness Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 19465 Deerfield Ave Ste 309, Lansdowne, Virginia |
| Authorized Official Name and Position | Olufunmilola M Ogbonlowo (PHYSICIAN) |
| Authorized Official Contact | 5712932424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Family Medicine And Wellness Pllc 19465 Deerfield Ave Ste 309 Lansdowne VA 20176-1705 Ph: (571) 293-2424 | Lighthouse Family Medicine And Wellness Pllc 19465 Deerfield Ave Ste 309 Lansdowne VA 20176-1705 Ph: (571) 293-2424 |
| NPI Number | 1164003752 |
|---|---|
| Provider Enumeration Date | 04/15/2021 |
| Last Update Date | 11/30/2021 |
| Medicare PECOS PAC ID | 3072922574 |
|---|---|
| Medicare Enrollment ID | O20210513002260 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164003752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Olufunmilola M Ogbonlowo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174926679 PECOS PAC ID: 4385993138 Enrollment ID: I20180828000936 |
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