Provider Demographics
NPI:1710450267
Name:BETHESDA MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:BETHESDA MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-265-8304
Mailing Address - Street 1:1620 BELLE CHASSE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7057
Mailing Address - Country:US
Mailing Address - Phone:504-265-8304
Mailing Address - Fax:504-322-2386
Practice Address - Street 1:1620 BELLE CHASSE HWY STE 101
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7057
Practice Address - Country:US
Practice Address - Phone:504-265-8304
Practice Address - Fax:504-322-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty