Organization
M CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZACHARY BUSH M.D. (DIRECTOR OF CLINICAL AFFAIRS)
(434) 321-5257
Entity
Organization
Contact information
Practice address
406 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22901
(434) 321-5257
(434) 321-5259
Mailing address
406 ALBEMARLE SQUARE, CHARLOTTESVILLE, VA 22901
(434) 321-5257
(434) 321-5259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101239018
VA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
0101239018
VA
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
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