Healthcare Provider Details

I. General information

NPI: 1740907088
Provider Name (Legal Business Name): MIRRORAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7803 GLENBROOK RD
BETHESDA MD
20814-1301
US

IV. Provider business mailing address

7803 GLENBROOK RD
BETHESDA MD
20814-1301
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-7071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HEMANT VASANT VIRKAR
Title or Position: FOUNDER AND CTO
Credential:
Phone: 301-728-7071