1952614455 NPI number — YMB SURGERY P.L.L.C.

Table of content: (NPI 1952614455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952614455 NPI number — YMB SURGERY P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YMB SURGERY P.L.L.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:
1952614455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10845 PHILADELPHIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE MARSH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21162-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-335-0008
Provider Business Mailing Address Fax Number:
410-335-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44084 RIVERSIDE PKWY
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
LANSDOWNE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-687-3158
Provider Business Practice Location Address Fax Number:
703-687-3166
Provider Enumeration Date:
07/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BARAKI
Authorized Official First Name:
YAQUB
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
SOLE MANAGER
Authorized Official Telephone Number:
818-970-4497

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB4QY . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E050 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 510466100 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 198107 . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 227971 . This is a "MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: X739 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com