Provider Demographics
NPI:1144704040
Name:BAO DINH DO PC
Entity type:Organization
Organization Name:BAO DINH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAO
Authorized Official - Middle Name:T
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-340-2989
Mailing Address - Street 1:3301 WOODBURN RD STE 311
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-828-0048
Mailing Address - Fax:
Practice Address - Street 1:3301 WOODBURN RD STE 311
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-828-0048
Practice Address - Fax:703-574-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144704040Medicaid