Provider Demographics
NPI:1063740199
Name:NEW FLOWER LLC
Entity type:Organization
Organization Name:NEW FLOWER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELAKU
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-200-5422
Mailing Address - Street 1:8439 LAKE MIST WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2676
Mailing Address - Country:US
Mailing Address - Phone:703-646-5500
Mailing Address - Fax:
Practice Address - Street 1:50 SOUTH PICKETT ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-370-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055711261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101055711OtherDEPARTMENT OF HEALTH PROFESSIONS
MDD0052560OtherMARYLAND BOARD OF PHYSCIANS