Healthcare Provider Details

I. General information

NPI: 1720107931
Provider Name (Legal Business Name): JACK ADAM YANOVSKI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR NIH HATFIELD CRC, RM 1E-3330 MSC 1103
BETHESDA MD
20892-1103
US

IV. Provider business mailing address

12035 MONTROSE VILLAGE TER
ROCKVILLE MD
20852-4162
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-0858
  • Fax: 301-402-0574
Mailing address:
  • Phone: 301-230-0186
  • Fax: 301-402-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberD38535
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: