1669814851 NPI number — YESHNIK AND ASSOCIATES MD PA

Table of content: DAVID K. KEETON CRNA (NPI 1821250366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669814851 NPI number — YESHNIK AND ASSOCIATES MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YESHNIK AND ASSOCIATES MD PA
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:
1669814851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 JERMOR LN
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-6151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-876-5400
Provider Business Mailing Address Fax Number:
410-871-9917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 JERMOR LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-6151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-876-5400
Provider Business Practice Location Address Fax Number:
410-871-9917
Provider Enumeration Date:
07/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
YESHNIK
Authorized Official First Name:
MELVIN
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-876-5400

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D0030191 , 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: 549371400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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