Individual
DR. PREMA MODAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3998 FAIR RIDGE DR STE 105, FAIRFAX, VA 22033-2980
(571) 349-2191
Mailing address
3998 FAIR RIDGE DR STE 105, FAIRFAX, VA 22033-2980
(571) 349-2191
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101240540
VA
207W00000X
Ophthalmology Physician
D0070139
MD
Other
Enumeration date
04/26/2007
Last updated
07/30/2019
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