1366961518 NPI number — MS. CHANICE TIARA YELDER I DO

Table of content: MS. CHANICE TIARA YELDER I DO (NPI 1366961518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366961518 NPI number — MS. CHANICE TIARA YELDER I DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YELDER
Provider First Name:
CHANICE
Provider Middle Name:
TIARA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
I
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YELDER
Provider Other First Name:
CHANICE
Provider Other Middle Name:
TIARA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366961518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1326 TRALEE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21001-2642
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1326 TRALEE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21001-2642
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
443-987-5907
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2017

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: 225500000X , with the licence number:  Y-436115793640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235500000X , with the licence number: Y-436115793640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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