Primary Gerontology Center Llc | |
4196 Merchant Plz Ste 348 Lake Ridge VA 22192-5085 | |
(571) 206-1650 | |
Not Available |
Full Name | Primary Gerontology Center Llc |
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Speciality | Family Medicine - Geriatric Medicine |
Location | 4196 Merchant Plz Ste 348, Lake Ridge, Virginia |
Authorized Official Name and Position | Jiho Choi (OWNER/STAFF PHYSICIAN) |
Authorized Official Contact | 5712061650 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Primary Gerontology Center Llc 4216 Evergreen Ln Ste 121 Annandale VA 22003-3256 Ph: (571) 206-1650 | Primary Gerontology Center Llc 4196 Merchant Plz Ste 348 Lake Ridge VA 22192-5085 Ph: (571) 206-1650 |
NPI Number | 1215425384 |
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Provider Enumeration Date | 04/24/2018 |
Last Update Date | 07/01/2020 |
Identifier | Type | State | Issuer |
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1215425384 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207QG0300X | Family Medicine - Geriatric Medicine | (Virginia) | Primary |
Amy L Friedenthal Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12512 Lake Ridge Dr Ste D, Lake Ridge, VA 22192 Phone: 703-497-5555 Fax: 703-497-1479 | |