Provider Demographics
NPI:1699938696
Name:BAKHEET, MARWAN A (MD)
Entity type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:A
Last Name:BAKHEET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARWAN
Other - Middle Name:A
Other - Last Name:BAKHEET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8355
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-8355
Mailing Address - Country:US
Mailing Address - Phone:646-275-4802
Mailing Address - Fax:
Practice Address - Street 1:120 YELLOWSTONE DR
Practice Address - Street 2:NO. 2
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-8109
Practice Address - Country:US
Practice Address - Phone:646-275-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254385207R00000X
NY272174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine