1306066386 NPI number — MARY A. YUENGERT MD, P.C.

Table of content: (NPI 1306066386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306066386 NPI number — MARY A. YUENGERT MD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY A. YUENGERT MD, P.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:
1306066386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11835 FISHING POINT DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-223-7097
Provider Business Mailing Address Fax Number:
757-223-7095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11835 FISHING POINT DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-223-7097
Provider Business Practice Location Address Fax Number:
757-223-7095
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YUENGERT
Authorized Official First Name:
MARY
Authorized Official Middle Name:
AGNES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-223-7097

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101041228 , 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: 0103451 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5785278 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 17652 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 236108 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2671966 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1383297 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 839478 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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