Healthcare Provider Details

I. General information

NPI: 1871784058
Provider Name (Legal Business Name): MOHAMMED BAYASI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY STE 310
RESTON VA
20190-3300
US

IV. Provider business mailing address

1850 TOWN CENTER PKWY STE 310
RESTON VA
20190-3300
US

V. Phone/Fax

Practice location:
  • Phone: 703-570-5227
  • Fax: 703-574-4645
Mailing address:
  • Phone: 832-494-7701
  • Fax: 703-574-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10029119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: