| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 07/01/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215425384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (Virginia) | Primary |
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