Provider Demographics
NPI:1902220403
Name:TRIUMPH MEDICAL ADVANCMENTS
Entity Type:Organization
Organization Name:TRIUMPH MEDICAL ADVANCMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAHEED
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-325-6504
Mailing Address - Street 1:PO BOX 3104
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177-8003
Mailing Address - Country:US
Mailing Address - Phone:845-325-6504
Mailing Address - Fax:
Practice Address - Street 1:43704 LEES MILL SQ
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3821
Practice Address - Country:US
Practice Address - Phone:845-325-6504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012540602081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty