Provider Demographics
NPI:1851173579
Name:MASUD BAKSH MD LLC
Entity Type:Organization
Organization Name:MASUD BAKSH MD LLC
Other - Org Name:VITAL HEALTH AND AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MASUD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-707-8518
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 340
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:571-707-8518
Mailing Address - Fax:
Practice Address - Street 1:20925 PROFESSIONAL PLZ STE 340
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:571-707-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty