Provider Demographics
NPI:1073567129
Name:YAN, TONY (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:YAN
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 1:6700 RIDGE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3960
Mailing Address - Country:US
Mailing Address - Phone:410-391-3434
Mailing Address - Fax:410-574-7574
Practice Address - Street 1:6700 RIDGE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-391-3434
Practice Address - Fax:410-574-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDD002366018207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD781651100Medicaid
9446Medicare ID - Type Unspecified
MD781651100Medicaid