1194895284 NPI number — DR. MARIA YIASSEMIDES D.C.

Table of content: DR. MARIA YIASSEMIDES D.C. (NPI 1194895284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194895284 NPI number — DR. MARIA YIASSEMIDES D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YIASSEMIDES
Provider First Name:
MARIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194895284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 SWEET AIR RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21131-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-628-0010
Provider Business Mailing Address Fax Number:
410-628-4837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3421 SWEET AIR RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21131-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-628-0010
Provider Business Practice Location Address Fax Number:
410-628-4837
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01553 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5265780 . This is a "AETNA NON-HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LT48 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 350045858 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522253872 . This is a "TAX ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4400252 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2145698 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T619 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 294856 . This is a "MAMSI. ALLIANCE, OPT. CH." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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