Provider Demographics
NPI:1003850900
Name:PRYKUPENKO, YURI (MD)
Entity Type:Individual
Prefix:DR
First Name:YURI
Middle Name:
Last Name:PRYKUPENKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3901
Mailing Address - Country:US
Mailing Address - Phone:301-231-0007
Mailing Address - Fax:301-231-0078
Practice Address - Street 1:4920 ELM ST STE 225
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-0007
Practice Address - Country:US
Practice Address - Phone:240-395-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007365207V00000X
MDD0070822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEI21890Medicare UPIN
DE015366K84Medicare ID - Type Unspecified