Healthcare Provider Details

I. General information

NPI: 1326075730
Provider Name (Legal Business Name): JOHN M YACKEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 SHADY GROVE RD SUITE 201
ROCKVILLE MD
20850-3254
US

IV. Provider business mailing address

15225 SHADY GROVE RD SUITE 201
ROCKVILLE MD
20850-3254
US

V. Phone/Fax

Practice location:
  • Phone: 301-670-3000
  • Fax: 301-924-0186
Mailing address:
  • Phone: 301-670-3000
  • Fax: 301-924-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0035261
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: