Provider Demographics
NPI:1205065174
Name:PREMIERE PRIMARY CARE CENTER, LLC
Entity type:Organization
Organization Name:PREMIERE PRIMARY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAKU
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUKOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-588-2888
Mailing Address - Street 1:8714 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3601
Mailing Address - Country:US
Mailing Address - Phone:301-588-2888
Mailing Address - Fax:301-589-2007
Practice Address - Street 1:8714 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3601
Practice Address - Country:US
Practice Address - Phone:301-588-2888
Practice Address - Fax:301-589-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty