1295711828 NPI number — DR. BU-FAN YU MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295711828 NPI number — DR. BU-FAN YU MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

YU

Provider First Name:

BU-FAN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1295711828

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/08/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1803 MT. ROSE AVENUE

Provider Second Line Business Mailing Address:

SUITE B3

Provider Business Mailing Address City Name:

YORK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17403-3051

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-851-1405

Provider Business Mailing Address Fax Number:

717-812-4087

Provider First Line Business Practice Location Address:

35 MONUMENT RD

Provider Second Line Business Practice Location Address:

SUITE 201

Provider Business Practice Location Address City Name:

YORK

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17403-5074

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-812-4083

Provider Business Practice Location Address Fax Number:

717-812-4087

Provider Enumeration Date:

12/15/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085N0700X , with the licence number:  MD07373176L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 2004001501 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: MD073176L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0204X , with the licence number: MD073176L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1804196 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 20078619 . This is a "AMERIHEALTH MERCY WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1573887 . This is a "GATEWAY WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 244783 . This is a "UNISON WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 919374 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 001906017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".