Provider Demographics
NPI:1649419276
Name:CLIFTON STATION LLC
Entity Type:Organization
Organization Name:CLIFTON STATION LLC
Other - Org Name:WALK-IN MEDICAL CARE FAIRFAX STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.BINA KOLOLGI
Authorized Official - Prefix:DR
Authorized Official - First Name:BINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLOLGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-495-9148
Mailing Address - Street 1:9015 SILVERBROOK RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2683
Mailing Address - Country:US
Mailing Address - Phone:703-495-9148
Mailing Address - Fax:
Practice Address - Street 1:9015 SILVERBROOK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-2683
Practice Address - Country:US
Practice Address - Phone:703-495-9148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty