Healthcare Provider Details

I. General information

NPI: 1992735104
Provider Name (Legal Business Name): YAROSLAV VAYNSHTEYN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAPIDUS CANCER INSTITUTE 2401 W BELVEDERE AVENUE
BALTIMORE MD
21215
US

IV. Provider business mailing address

2401 W BELVEDERE AVE ATTN: CREDENTIALING
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-4710
  • Fax:
Mailing address:
  • Phone: 410-601-5524
  • Fax: 410-601-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR147752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: