Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101232738 | VA |
N | 111NI0900X | Internist | 0101232738 | VA |
Y | 207R00000X | Internist | MD33941 | DC |
Y | 111NI0900X | Internist | MD33941 | DC |
N | 207RC0200X | Critical Care Medicine | D0063530 | MD |
N | 207RC0200X | Critical Care Medicine | MD33941 | DC |
N | 207RP1001X | Pulmonary Disease | D0063530 | MD |
N | 207RP1001X | Pulmonary Disease | MD33941 | DC |
NPI | 1073519823 |
---|---|
Provider Name | Dr. Mina M Yacoub |
First Address | Washington, DC 20020 |
Second Address | Washington, DC 20020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6875-0048 | CAREFIRST BLUE CROSS (01) | |
I07376 | (02) | |
P00381288 | UHC RAILROAD (01) |