Provider Demographics
NPI:1114198835
Name:YDIPRMC LLC
Entity Type:Organization
Organization Name:YDIPRMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORNMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-944-3351
Mailing Address - Street 1:327 TILGHMAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2015
Mailing Address - Country:US
Mailing Address - Phone:443-210-2542
Mailing Address - Fax:410-334-6352
Practice Address - Street 1:2425 N SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2138
Practice Address - Country:US
Practice Address - Phone:877-222-4934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20235706261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDD9023OtherRAILROAD MEDICARE
MD408316400Medicaid
MD313541OtherCOVENTRY
MD2145659ML2OtherMAMSI
MD2145659ML2OtherOPTIMUM CHOICE
MD248783OtherANTHEM
MD3780-0000OtherBLUE CHOICE
MD7603709OtherAETNA
MD11ZMOtherBLUE CROSS BLUE SHIELD
MD2145659ML2OtherMDIPA
MD3780-0000OtherBLUE CROSS FEDERAL
MD2145659ML2OtherMDIPA
MD248783OtherANTHEM
MD3780-0000OtherBLUE CROSS FEDERAL