Bahru Llc | |
122 Morven Park Rd Nw Leesburg VA 20176-2024 | |
(571) 246-3628 | |
Not Available |
Full Name | Bahru Llc |
---|---|
Speciality | Internal Medicine |
Location | 122 Morven Park Rd Nw, Leesburg, Virginia |
Authorized Official Name and Position | Membere Bahru (OWNER) |
Authorized Official Contact | 5712463628 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Bahru Llc 43713 Red House Dr Leesburg VA 20176-1628 Ph: (571) 246-3628 | Bahru Llc 122 Morven Park Rd Nw Leesburg VA 20176-2024 Ph: (571) 246-3628 |
NPI Number | 1508607722 |
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Provider Enumeration Date | 06/03/2024 |
Last Update Date | 06/03/2024 |
Medicare PECOS PAC ID | 8224579230 |
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Medicare Enrollment ID | O20240918000983 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508607722 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Menbere Bahru |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1528130218 PECOS PAC ID: 4789787284 Enrollment ID: I20070320000694 |
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