Healthcare Provider Details

I. General information

NPI: 1619963162
Provider Name (Legal Business Name): THOMAS C YU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 ROCK SPRING DR STE 105
BETHESDA MD
20817
US

IV. Provider business mailing address

6500 ROCK SPRING DR STE 105
BETHESDA MD
20817-1154
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-8300
  • Fax: 301-530-4638
Mailing address:
  • Phone: 301-530-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0063201
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD0063201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: