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General NPI Number Information
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NPI Number | 1205122330
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Entity Type | Organization
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Legal Business Name | BAY MEDICAL CARE LLC
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 4010 MAURY PL STE 8B
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2340
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Country | US
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Telephone | 703-665-0508
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 MAURY PL STE 8B
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DHIRGHAM KSHASH
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Credential | M.D.
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Telephone | 914-217-0802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0101249593
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License Number State | VA
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