MEDICARE: BAY MEDICAL CARE 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	261Q00000X	Clinic/Center	0101249593	VA

General Provider Information

NPI Number	:	1205122330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY MEDICAL CARE LLC

Provider Business Mailing Address
First Line	:	4010 MAURY PL
Second Line	:	STE 8B
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 MAURY PL
Second Line	:	STE 8B
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2340
Country	:	US
Telephone Number	:	703-665-0508
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DHIRGHAM KSHASH
Credential	:	M.D.
Telephone Number	:	914-217-0802

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	07/20/2011

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