Provider Demographics
NPI:1568275600
Name:PREMIER PRIMARY CARE LLC
Entity type:Organization
Organization Name:PREMIER PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHIZADEHMOGHADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-269-4770
Mailing Address - Street 1:PO BOX 34202
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20827-0202
Mailing Address - Country:US
Mailing Address - Phone:301-979-9772
Mailing Address - Fax:301-355-0076
Practice Address - Street 1:3546 WORTHINGTON BLVD UNIT 301
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7126
Practice Address - Country:US
Practice Address - Phone:301-979-9772
Practice Address - Fax:301-355-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty