Healthcare Provider Details

I. General information

NPI: 1841361086
Provider Name (Legal Business Name): YOLANDRA HANCOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14526 CHURCH ST
UPPER MARLBORO MD
20772-3040
US

IV. Provider business mailing address

14526 CHURCH ST
UPPER MARLBORO MD
20772-3040
US

V. Phone/Fax

Practice location:
  • Phone: 301-304-4939
  • Fax: 301-327-1749
Mailing address:
  • Phone: 301-304-4939
  • Fax: 301-327-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035513
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: