Provider Demographics
NPI:1235124660
Name:IBADOVA, YELENA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:IBADOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SUMAC TER
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6281
Mailing Address - Country:US
Mailing Address - Phone:410-925-9571
Mailing Address - Fax:
Practice Address - Street 1:1020 SUMAC TER
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6281
Practice Address - Country:US
Practice Address - Phone:410-925-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical