MEDICARE: DR. MARIA YIASSEMIDES D.C.

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	111N00000X	Chiropractor	01553	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	350045858	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5265780	OTHER	MD	AETNA NON-HMO
2	LT48	OTHER	MD	BLUECROSSBLUESHIELD
4	522253872	OTHER	MD	TAX ID
5	4400252	OTHER	MD	UNITED HEALTH CARE
6	2145698	OTHER	MD	AETNA HMO
7	T619	OTHER	DC	BLUECROSSBLUESHIELD
8	294856	OTHER	MD	MAMSI. ALLIANCE, OPT. CH.

General Provider Information

NPI Number	:	1194895284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA YIASSEMIDES D.C.

Provider Business Mailing Address
First Line	:	3421 SWEET AIR RD
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	MD
Zip	:	21131-1812
Country	:	US
Telephone Number	:	410-628-0010
Fax Number	:	410-628-4837

Provider Business Practice Location Address
First Line	:	3421 SWEET AIR RD
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	MD
Zip	:	21131-1812
Country	:	US
Telephone Number	:	410-628-0010
Fax Number	:	410-628-4837

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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