Provider Demographics
NPI:1720246986
Name:ENEBISH, UUGANBAYAR (PA C)
Entity Type:Individual
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First Name:UUGANBAYAR
Middle Name:
Last Name:ENEBISH
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Gender:F
Credentials:PA C
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Mailing Address - Street 1:115 PARK ST SE SUITE 300
Mailing Address - Street 2:VIENNA FAMILY MEDICINE
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4653
Mailing Address - Country:US
Mailing Address - Phone:703-255-9100
Mailing Address - Fax:703-255-3457
Practice Address - Street 1:115 PARK ST SE SUITE 300
Practice Address - Street 2:VIENNA FAMILY MEDICINE
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4653
Practice Address - Country:US
Practice Address - Phone:703-255-9100
Practice Address - Fax:703-255-3457
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-11-10
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Provider Licenses
StateLicense IDTaxonomies
VA0110002358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant