Provider Demographics
NPI:1124012166
Name:YESHNIK, MELVIN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:ANTHONY
Last Name:YESHNIK
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 1:511 JERMOR LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6151
Mailing Address - Country:US
Mailing Address - Phone:410-876-5400
Mailing Address - Fax:410-871-9917
Practice Address - Street 1:511 JERMOR LN
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6151
Practice Address - Country:US
Practice Address - Phone:410-876-5400
Practice Address - Fax:410-871-9917
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO30191207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD661116800Medicaid
MD304279Medicare PIN
MD661116800Medicaid