Basic Information
| Provider Information | |||||||||
| NPI: | 1003338237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YARBROUGH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | WILBUR | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2739 RABORN RD | ||||||||
| Address2: | |||||||||
| City: | HEPHZIBAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308154946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065130398 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2215 BURDETT AVE | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121802466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182713300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 020899 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.