Basic Information
Provider Information
NPI: 1003014986
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YUZEFOVICH
FirstName: MICHAEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2301 E ST NW APT A1009
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200372839
CountryCode: US
TelephoneNumber: 7324706453
FaxNumber:  
Practice Location
Address1: 8302 OLD COURTHOUSE RD STE A
Address2:  
City: VIENNA
State: VA
PostalCode: 221823873
CountryCode: US
TelephoneNumber: 7034489140
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/03/2007
LastUpdateDate: 09/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X0101241614VAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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