Healthcare Provider Details

I. General information

NPI: 1952614455
Provider Name (Legal Business Name): YMB SURGERY P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44084 RIVERSIDE PKWY SUITE 230
LANSDOWNE VA
20176-5102
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 703-687-3158
  • Fax: 703-687-3166
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YAQUB M. BARAKI
Title or Position: SOLE MANAGER
Credential: M.D.
Phone: 818-970-4497