Organization
MIND BRIDGE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURWA NYIGU MD (CEO)
(336) 624-7164
Entity
Organization
Contact information
Practice address
1390 CHAIN BRIDGE RD # 10033, MC LEAN, VA 22101-3904
(571) 766-8107
Mailing address
1390 CHAIN BRIDGE RD # 10033, MC LEAN, VA 22101-3904
(571) 766-8107
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
04/10/2020
Last updated
04/10/2020
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