Provider Demographics
NPI:1376632661
Name:CVETKOVICH, LORNA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:LYNN
Last Name:CVETKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 FAIR RIDGE DR STE 304
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2917
Mailing Address - Country:US
Mailing Address - Phone:703-273-9440
Mailing Address - Fax:703-273-9445
Practice Address - Street 1:4001 FAIR RIDGE DR STE 304
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-273-9440
Practice Address - Fax:703-273-9445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080442207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4441193Medicaid
MI4441193Medicaid
BC1918765OtherDEA
E42624Medicare UPIN