MEDICARE: DR. JOHN K YACOUB MD

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	207V00000X	Obstetrics & Gynecology Physician	D0030010	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0049	OTHER	MD	CAREFIRST-DC
2	351970-04	OTHER	MD	CAREFIRST-MD

General Provider Information

NPI Number	:	1902903826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN K YACOUB MD

Provider Business Mailing Address
First Line	:	PO BOX 21182
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21228-0682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 PINE HEIGHTS AVE
Second Line	:	SUITE 203
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5208
Country	:	US
Telephone Number	:	410-644-1454
Fax Number	:	410-525-8645

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/15/2011

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Directions to “ DR. JOHN K YACOUB MD” Practice Location

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