Provider Demographics
NPI:1952614455
Name:YMB SURGERY P.L.L.C.
Entity Type:Organization
Organization Name:YMB SURGERY P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YAQUB
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-970-4497
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:44084 RIVERSIDE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-5102
Practice Address - Country:US
Practice Address - Phone:703-687-3158
Practice Address - Fax:703-687-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCB4QYOtherCAREFIRST
VAE050OtherMEDICARE
MD510466100OtherMEDICAL ASSISTANCE
MD198107OtherMEDICARE
DC227971OtherMEDICARE
DCX739OtherCAREFIRST