1336191725 NPI number — DR. MELISSA YADAO M.D.

Table of content: DR. MELISSA YADAO M.D. (NPI 1336191725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336191725 NPI number — DR. MELISSA YADAO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YADAO
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1336191725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8926 WOODYARD RD
Provider Second Line Business Mailing Address:
SUITE 701
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-1682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8101 HINSON FARM RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22306-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-1682
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

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: 207X00000X , with the licence number:  0101058134 , 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: 145530100 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176608 . This is a "METRO MEDICARE GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010017637 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4695-0043 . This is a "CAREFIRST NCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 017482YZW . This is a "METRO MEDICARE INDIVIDUAL PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10981133 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00887808 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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