MEDICARE: DR. YITAO MA MD

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	2084E0001X	Epilepsy Physician	D72987	MD
2	2084N0600X	Clinical Neurophysiology Physician	D72987	MD
3	2084N0400X	Neurology Physician	D72987	MD

General Provider Information

NPI Number	:	1356595763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YITAO MA MD

Provider Business Mailing Address
First Line	:	8901 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-0004
Country	:	US
Telephone Number	:	301-295-4771
Fax Number	:	301-295-4759

Provider Business Practice Location Address
First Line	:	8901 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889
Country	:	US
Telephone Number	:	301-295-4771
Fax Number	:	301-295-4759

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	08/27/2024

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