Healthcare Provider Details

I. General information

NPI: 1902220403
Provider Name (Legal Business Name): TRIUMPH MEDICAL ADVANCMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43704 LEES MILL SQ
LEESBURG VA
20176-3821
US

IV. Provider business mailing address

PO BOX 3104
LEESBURG VA
20177-8003
US

V. Phone/Fax

Practice location:
  • Phone: 845-325-6504
  • Fax:
Mailing address:
  • Phone: 845-325-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101254060
License Number StateVA

VIII. Authorized Official

Name: WAHEED BAKSH
Title or Position: CEO
Credential: MD
Phone: 845-325-6504