Provider Demographics
NPI:1093721656
Name:YEH, I-TIEN (MD)
Entity Type:Individual
Prefix:
First Name:I-TIEN
Middle Name:
Last Name:YEH
Suffix:
Gender:F
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:PO BOX 7308
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-0308
Mailing Address - Country:US
Mailing Address - Phone:800-292-1387
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:502-456-7075
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250125207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1022-0010OtherBC/BS CAREFIRST
DC059200700Medicaid
VA1093721656Medicaid
MD1022-0010OtherBC/BS CAREFIRST