1902952187 NPI number — DR. MELISSA MARIE YATES M.D.

Table of content: DR. HANNA STEVENS M.D. (NPI 1255528196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902952187 NPI number — DR. MELISSA MARIE YATES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YATES
Provider First Name:
MELISSA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1902952187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5557
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-5500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-493-2229
Provider Business Mailing Address Fax Number:
904-387-1497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7051 SOUTHPOINT PKWY S
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-8713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-493-2229
Provider Business Practice Location Address Fax Number:
904-387-1497
Provider Enumeration Date:
01/28/2007

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:  ME115169 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VE0102X , with the licence number: ME115169 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015125400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com