Healthcare Provider Details

I. General information

NPI: 1003850900
Provider Name (Legal Business Name): YURI PRYKUPENKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 ELM ST STE 225
BETHESDA MD
20814-0007
US

IV. Provider business mailing address

6171 EXECUTIVE BLVD
ROCKVILLE MD
20852-3901
US

V. Phone/Fax

Practice location:
  • Phone: 240-395-1050
  • Fax:
Mailing address:
  • Phone: 301-231-0007
  • Fax: 301-231-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC10007365
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0070822
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: