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NPI Code Detail

MEDICARE: BAY MEDICAL CARE LLC

MEDICARE: BAY MEDICAL CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center0101249593VA

General Provider Information

NPI Number : 1205122330
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAY MEDICAL CARE LLC
Provider Business Mailing Address
First Line : 4010 MAURY PL
Second Line : STE 8B
City : ALEXANDRIA
State : VA
Zip : 22309-2340
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4010 MAURY PL
Second Line : STE 8B
City : ALEXANDRIA
State : VA
Zip : 22309-2340
Country : US
Telephone Number : 703-665-0508
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DHIRGHAM KSHASH
Credential : M.D.
Telephone Number : 914-217-0802
Provider Enumeration Date : 06/28/2011
Last Update Date : 07/20/2011

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Directions to “BAY MEDICAL CARE LLC ” Practice Location

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