Provider Demographics
NPI:1891396107
Name:MEDACUTE CARE LLC
Entity Type:Organization
Organization Name:MEDACUTE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENKESHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-602-6207
Mailing Address - Street 1:2907 BEAU LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1929
Practice Address - Country:US
Practice Address - Phone:443-602-6207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty