Healthcare Provider Details

I. General information

NPI: 1437527439
Provider Name (Legal Business Name): YODIT YIRGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

707 YORK RD APT 6216
TOWSON MD
21204-2546
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: