Provider Demographics
NPI:1538117783
Name:MEDICAL PRO, INC.
Entity Type:Organization
Organization Name:MEDICAL PRO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERHAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-227-5493
Mailing Address - Street 1:840 JUNIPER CRES
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2628
Mailing Address - Country:US
Mailing Address - Phone:757-227-5493
Mailing Address - Fax:757-227-5603
Practice Address - Street 1:840 JUNIPER CRES
Practice Address - Street 2:SUITE 104
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2628
Practice Address - Country:US
Practice Address - Phone:757-227-5493
Practice Address - Fax:757-227-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05066332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies