Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | C10007365 | DE |
Y | 207V00000X | Obstetrician & Gynecologist | D0070822 | MD |
NPI | 1003850900 |
---|---|
Provider Name | Dr. Yuri Prykupenko |
First Address | Rockville, MD 20852-3901 |
Second Address | Rockville, MD 20852-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I21890 | (02) | DE |