Healthcare Provider Details

I. General information

NPI: 1053958710
Provider Name (Legal Business Name): SUSAN YANOVSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 ROCKVILLE PIKE
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

12035 MONTROSE VILLAGE TER
ROCKVILLE MD
20852-4162
US

V. Phone/Fax

Practice location:
  • Phone: 301-221-8402
  • Fax:
Mailing address:
  • Phone: 301-221-8402
  • Fax: 301-480-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD38449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: