# M CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043725336
- **Authorized official:** ZACHARY BUSH M.D. (DIRECTOR OF CLINICAL AFFAIRS)
- **Authorized official phone:** (434) 321-5257

## Contact information

- **Practice address:** 406 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22901
- **Practice address phone:** (434) 321-5257
- **Practice address fax:** (434) 321-5259
- **Mailing address:** 406 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22901
- **Mailing address phone:** (434) 321-5257
- **Mailing address fax:** (434) 321-5259

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 0101239018 | VA | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 0101239018 | VA | Yes |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | 0101239018 | VA | — |
| 363LF0000X | Family Nurse Practitioner | 0024166491 | VA | — |

## Other

- **Enumeration date:** 12/08/2017
- **Last updated:** 12/08/2017