Healthcare Provider Details

I. General information

NPI: 1811293046
Provider Name (Legal Business Name): YMS BUSHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2011
Last Update Date: 02/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 GREENSBORO DR SUITE 908
MC LEAN VA
22102-3533
US

IV. Provider business mailing address

8350 GREENSBORO DR SUITE 908
MC LEAN VA
22102-3533
US

V. Phone/Fax

Practice location:
  • Phone: 941-744-6147
  • Fax: 703-790-1616
Mailing address:
  • Phone: 941-744-6147
  • Fax: 703-790-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101-043674
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: