Provider Demographics
NPI:1285654053
Name:YUSSMAN, MARVIN AARON (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:AARON
Last Name:YUSSMAN
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0329
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:STE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-588-4400
Practice Address - Fax:502-588-4401
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13044207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64130446Medicaid
KY1049351OtherPASSPORT PCP
KY50004028OtherPASSPORT SPECIALITY
IN100333900Medicaid
KY000000047610OtherANTHEM
KY1049351OtherPASSPORT PCP
KYC66536Medicare UPIN
KY64130446Medicaid