MEDICARE: DR. YAACOV PUSHKIN M.D.

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	2084P0800X	Psychiatry Physician	0101047546	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790866812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAACOV PUSHKIN M.D.

Provider Business Mailing Address
First Line	:	5213 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	804-237-8030
Fax Number	:	804-237-8028

Provider Business Practice Location Address
First Line	:	5213 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	804-237-8030
Fax Number	:	804-237-8028

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/11/2012

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