Provider Demographics
NPI:1083103592
Name:PREMIER OB/GYN ASSOCIATES LLC
Entity Type:Organization
Organization Name:PREMIER OB/GYN ASSOCIATES LLC
Other - Org Name:MODERN CARE OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AFRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-258-2580
Mailing Address - Street 1:11118 SWEETWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1340
Mailing Address - Country:US
Mailing Address - Phone:202-258-2580
Mailing Address - Fax:
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 102
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1737
Practice Address - Country:US
Practice Address - Phone:202-258-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101242511OtherMEDICAL LICENCE
VA1295938751Medicaid
VAFA0458302OtherDEA