Healthcare Provider Details

I. General information

NPI: 1902535271
Provider Name (Legal Business Name): JOSEPH XAVIER PAVILLAR YAP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5270
US

IV. Provider business mailing address

5506 MAUDES WAY
WHITE MARSH MD
21162-3417
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR239485
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR239485
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR239485
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024195106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: