Provider Demographics
NPI:1336122381
Name:LARSEN, YLENE A (MD)
Entity Type:Individual
Prefix:
First Name:YLENE
Middle Name:A
Last Name:LARSEN
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:PO BOX 79170
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0170
Mailing Address - Country:US
Mailing Address - Phone:301-656-7374
Mailing Address - Fax:301-656-1019
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-7374
Practice Address - Fax:301-656-1019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022599207RP1001X
DCMD13095207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93540Medicare UPIN
MD127077L73Medicare ID - Type Unspecified