1083831606 NPI number — JOHN E YERG II MD PLLC

Table of content: MRS. ROSA CELESTE SIDY LMT (NPI 1225448657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083831606 NPI number — JOHN E YERG II MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN E YERG II MD PLLC
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:
1083831606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 CONNECTICUT AVE NW
Provider Second Line Business Mailing Address:
STE 117
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20015-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-966-8868
Provider Business Mailing Address Fax Number:
202-244-3071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5410 CONNECTICUT AVE NW
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20015-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-966-8868
Provider Business Practice Location Address Fax Number:
202-244-3071
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YERG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
202-966-8868

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  15876 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 518805 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: G589 . This is a "BLUECROSSBLUESHIELD" identifier . This identifiers is of the category "OTHER".




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