Healthcare Provider Details

I. General information

NPI: 1417489220
Provider Name (Legal Business Name): MICHAEL YACOVELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR DEPT OF
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR DEPT OF
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7046
  • Fax: 202-877-7633
Mailing address:
  • Phone: 443-777-7046
  • Fax: 202-877-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0088429
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: