MEDICARE: DR. ELAINE MIDORI YAMADA PH.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	103T00000X	Psychologist	00985	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7913 0001	OTHER	MD	FEP
3	002571	OTHER	MD	VALUEOPTIONS
4	G985EM	OTHER	MD	CAREFIRST BLUECROSS BLUES

General Provider Information

NPI Number	:	1720137847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELAINE MIDORI YAMADA PH.D.

Provider Business Mailing Address
First Line	:	4511 CLIFTON RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-1646
Country	:	US
Telephone Number	:	410-664-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 CLIFTON RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-1646
Country	:	US
Telephone Number	:	410-664-2031
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/05/2011

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