Provider Demographics
NPI:1801993852
Name:LOTFI, PAYMAUN M (MD)
Entity type:Individual
Prefix:
First Name:PAYMAUN
Middle Name:M
Last Name:LOTFI
Suffix:
Gender:M
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:PO BOX 5237
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22194-5237
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8732
Practice Address - Street 1:14605 POTOMAC BRANCH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4070
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:703-878-8732
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840469207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006401066Medicaid
VA006401066Medicaid
VA00V944N01Medicare PIN