MEDICARE: YORCKAY C ISHIZAWAR MD INC

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	261Q00000X	Clinic/Center	02303295	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003865924	OTHER	VA	INDIVIDUAL NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023270113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YORCKAY C ISHIZAWAR MD INC

Provider Business Mailing Address
First Line	:	211 TEMPLE AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2827
Country	:	US
Telephone Number	:	804-526-0107
Fax Number	:	804-526-4466

Provider Business Practice Location Address
First Line	:	211 TEMPLE AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2827
Country	:	US
Telephone Number	:	804-526-0107
Fax Number	:	804-526-4466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YORCKAY C ISHIZAWAR
Credential	:	M.D.
Telephone Number	:	804-536-0107

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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