Healthcare Provider Details

I. General information

NPI: 1295796704
Provider Name (Legal Business Name): MING YI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MAIDEN CHOICE LN
CATONSVILLE MD
21228-3632
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-5602
  • Fax:
Mailing address:
  • Phone: 410-402-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0055391
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0055391
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: