Provider Demographics
NPI:1144222746
Name:YAKUBOV, LYN E (MD)
Entity Type:Individual
Prefix:DR
First Name:LYN
Middle Name:E
Last Name:YAKUBOV
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 1:10 DUTTON DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1818
Mailing Address - Country:US
Mailing Address - Phone:330-746-7691
Mailing Address - Fax:330-743-8368
Practice Address - Street 1:10 DUTTON DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1818
Practice Address - Country:US
Practice Address - Phone:330-746-7691
Practice Address - Fax:330-743-8368
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055476207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0800740OtherUNITED HEALTHCARE
OH180023970OtherRAILROAD MEDICARE
OH82800OtherQUALCHOICE
OH000000126328OtherANTHEM
OH0672731Medicaid
OHZ55476OtherSUMMACARE
PA0015728340004OtherMEDICAID
OH178994OtherKEYSTONE
OH4512389OtherAETNA
OH0693512Medicare PIN
OHE87012Medicare UPIN