Provider Demographics
NPI:1619185246
Name:MODJOROS, MELANIE ELISE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELISE
Last Name:MODJOROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVENUE
Mailing Address - Street 2:STE. 902
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1306
Mailing Address - Country:US
Mailing Address - Phone:703-370-4300
Mailing Address - Fax:703-370-1683
Practice Address - Street 1:4660 KENMORE AVENUE
Practice Address - Street 2:STE. 902
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:703-370-4300
Practice Address - Fax:703-370-1683
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101247238207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology