Provider Demographics
NPI:1225438385
Name:GLOBA'LL PRIMARY CARE & INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:GLOBA'LL PRIMARY CARE & INTERNAL MEDICINE, P.C.
Other - Org Name:GLOBA'LL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:ASSEFA
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD,
Authorized Official - Phone:703-823-4000
Mailing Address - Street 1:50 PICKETT STREET
Mailing Address - Street 2:SUITE 221
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4708
Mailing Address - Country:US
Mailing Address - Phone:703-823-4000
Mailing Address - Fax:703-823-4004
Practice Address - Street 1:50 PICKETT STREET
Practice Address - Street 2:SUITE 221
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4708
Practice Address - Country:US
Practice Address - Phone:703-823-4000
Practice Address - Fax:703-823-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty