1306066386 NPI number — MARY A. YUENGERT MD, P.C.

Table of content: JULIE LYNN MARKLEY PTA (NPI 1679716518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306066386 NPI number — MARY A. YUENGERT MD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY A. YUENGERT MD, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306066386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11835 FISHING POINT DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-223-7097
Provider Business Mailing Address Fax Number:
757-223-7095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11835 FISHING POINT DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-223-7097
Provider Business Practice Location Address Fax Number:
757-223-7095
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YUENGERT
Authorized Official First Name:
MARY
Authorized Official Middle Name:
AGNES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-223-7097

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101041228 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0103451 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5785278 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 17652 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 236108 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2671966 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1383297 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 839478 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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