Healthcare Provider Details

I. General information

NPI: 1215999560
Provider Name (Legal Business Name): LAUREL G YAP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST SUITE 211
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

3001 S HANOVER ST SUITE 211
BALTIMORE MD
21225-1233
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-2173
  • Fax:
Mailing address:
  • Phone: 410-350-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0029003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: