Provider Demographics
NPI:1841414331
Name:WILLIAM BARA-JIMENEZ, MD LLC
Entity Type:Organization
Organization Name:WILLIAM BARA-JIMENEZ, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARA-JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-221-8052
Mailing Address - Street 1:11119 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3143
Mailing Address - Country:US
Mailing Address - Phone:301-816-9000
Mailing Address - Fax:301-816-0295
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
Practice Address - Country:US
Practice Address - Phone:240-221-8052
Practice Address - Fax:240-221-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherEIN
MDG02490Medicare PIN