Healthcare Provider Details

I. General information

NPI: 1740539485
Provider Name (Legal Business Name): BAHAA KARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 21ST STNW #2932
WASHINGTON DC
20520
US

IV. Provider business mailing address

3827 8TH ST SOUTH
ARLINGTON VA
22204
US

V. Phone/Fax

Practice location:
  • Phone: 202-258-0796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMT216
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: