1053302596 NPI number — ELEANOR H YOON MD

Table of content: ELEANOR H YOON MD (NPI 1053302596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053302596 NPI number — ELEANOR H YOON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOON
Provider First Name:
ELEANOR
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1053302596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-3174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-423-5699
Provider Business Mailing Address Fax Number:
571-423-5698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 ARLINGTON BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-560-1611
Provider Business Practice Location Address Fax Number:
703-573-0210
Provider Enumeration Date:
11/03/2005

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: 207V00000X , with the licence number:  0101235841 , 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: 115857 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 533606 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540894297 . This is a "GW ONE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34300009 . This is a "BCBS OF DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0703850 . This is a "UNHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 379651 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3503396 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 379651 . This is a "MDIPA OPTIMUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5569742 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01-0097592 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540894297 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9068176003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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