MEDICARE: PREMIER OB/GYN ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101242511	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101242511	OTHER	VA	MEDICAL LICENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083103592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER OB/GYN ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	11118 SWEETWOOD LN
Second Line	:
City	:	OAKTON
State	:	VA
Zip	:	22124-1340
Country	:	US
Telephone Number	:	202-258-2580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 JOSEPH SIEWICK DR STE 102
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1737
Country	:	US
Telephone Number	:	202-258-2580
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. DAVID AFRAM
Credential	:	MD
Telephone Number	:	202-258-2580

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	03/07/2023

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