=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952980245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMNET YIBELTAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2021
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6201 ANNAPOLIS RD
-----------------------------------------------------
City | LANDOVER HILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20784-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-276-3377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1631 11TH ST UNIT B
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76301-4332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-263-3000
-----------------------------------------------------
Fax | 940-263-3018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | V2344
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D0102051
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------