Provider Demographics
NPI:1205122330
Name:BAY MEDICAL CARE LLC
Entity type:Organization
Organization Name:BAY MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DHIRGHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KSHASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-217-0802
Mailing Address - Street 1:4010 MAURY PL
Mailing Address - Street 2:STE 8B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4010 MAURY PL
Practice Address - Street 2:STE 8B
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2340
Practice Address - Country:US
Practice Address - Phone:703-665-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249593261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center