MEDICARE: BETTY YURGANOVA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	C0007066	MD

General Provider Information

NPI Number	:	1629542261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY YURGANOVA PA-C

Provider Business Mailing Address
First Line	:	10812 SHERWOOD HILL RD
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5846
Country	:	US
Telephone Number	:	410-227-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	14237 JARRETTSVILLE PIKE
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-1403
Country	:	US
Telephone Number	:	410-650-4735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/16/2019

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Directions to “ BETTY YURGANOVA PA-C” Practice Location

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