Healthcare Provider Details

I. General information

NPI: 1720246986
Provider Name (Legal Business Name): UUGANBAYAR ENEBISH PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PARK ST SE SUITE 300 VIENNA FAMILY MEDICINE
VIENNA VA
22180-4653
US

IV. Provider business mailing address

115 PARK ST SE SUITE 300 VIENNA FAMILY MEDICINE
VIENNA VA
22180-4653
US

V. Phone/Fax

Practice location:
  • Phone: 703-255-9100
  • Fax: 703-255-3457
Mailing address:
  • Phone: 703-255-9100
  • Fax: 703-255-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002358
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: