MEDICARE: MEDACUTE 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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1891396107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDACUTE CARE LLC

Provider Business Mailing Address
First Line	:	2907 BEAU LN
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-1324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 SKYVIEW DR
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1929
Country	:	US
Telephone Number	:	443-602-6207
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. ARDALAN ENKESHAFI
Credential	:	MD
Telephone Number	:	443-602-6207

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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