Provider Demographics
NPI:1326068826
Name:YUDKOFF, MIRIAM MIMI (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:MIMI
Last Name:YUDKOFF
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 1:2003 MEDICAL PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7992
Mailing Address - Country:US
Mailing Address - Phone:410-224-2228
Mailing Address - Fax:410-266-7778
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-224-2228
Practice Address - Fax:410-266-7778
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21546207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1212266OtherUNITED HEALTH CARE
MD11670001OtherBLUE SHIELD, FEDERAL
MD42306701OtherBLUE SHIELD, MARYLAND
MD225050OtherMAMSI/ALLIANCE
MD225050OtherMAMSI/ALLIANCE
MD42306701OtherBLUE SHIELD, MARYLAND