MEDICARE: DR. YURI PRYKUPENKO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	C10007365	DE
2	207V00000X	Obstetrics & Gynecology Physician	D0070822	MD

General Provider Information

NPI Number	:	1003850900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YURI PRYKUPENKO M.D.

Provider Business Mailing Address
First Line	:	6171 EXECUTIVE BLVD
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-3901
Country	:	US
Telephone Number	:	301-231-0007
Fax Number	:	301-231-0078

Provider Business Practice Location Address
First Line	:	4920 ELM ST STE 225
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-0007
Country	:	US
Telephone Number	:	240-395-1050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	01/05/2023

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