Provider Demographics
NPI:1508344060
Name:WINSLOW PRIMARY CARE ALLIANCE, LLC
Entity Type:Organization
Organization Name:WINSLOW PRIMARY CARE ALLIANCE, LLC
Other - Org Name:PRIMARY CARE AT HOME PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:ALLEN WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:703-673-8223
Mailing Address - Street 1:4000 LEGATO RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2893
Mailing Address - Country:US
Mailing Address - Phone:703-896-7711
Mailing Address - Fax:703-896-7601
Practice Address - Street 1:4000 LEGATO RD STE 1100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2893
Practice Address - Country:US
Practice Address - Phone:703-896-7711
Practice Address - Fax:703-896-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty