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General NPI Number Information
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NPI Number | 1952614455
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Entity Type | Organization
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Legal Business Name | YMB SURGERY P.L.L.C.
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 44084 RIVERSIDE PKWY SUITE 230
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City | LANSDOWNE
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State | VA
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Zip | 20176-5102
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Country | US
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Telephone | 703-687-3158
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Fax | 703-687-3166
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Provider Business Mailing Address
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Address Line | 10845 PHILADELPHIA RD
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City | WHITE MARSH
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State | MD
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Zip | 21162-1717
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Country | US
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Telephone | 410-335-0008
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Fax | 410-335-3113
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Authorized Official
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Title or Position | SOLE MANAGER
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Name | YAQUB M. BARAKI
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Credential | M.D.
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Telephone | 818-970-4497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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