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4000 Legato Rd Ste 1100 Fairfax VA 22033-2893 | |
| (703) 896-7711 | |
| (703) 896-7601 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4000 Legato Rd Ste 1100, Fairfax, Virginia |
| Authorized Official Name and Position | Erica Monique Allen Winslow (OWNER) |
| Authorized Official Contact | 7036738223 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4000 Legato Rd Ste 1100 Fairfax VA 22033-2893 Ph: (703) 896-7711 | 4000 Legato Rd Ste 1100 Fairfax VA 22033-2893 Ph: (703) 896-7711 |
| NPI Number | 1508344060 |
|---|---|
| Provider Enumeration Date | 08/06/2018 |
| Last Update Date | 08/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508344060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101252657 (Virginia) | Primary |
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