Provider Demographics
NPI:1346249695
Name:YOBURN, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:YOBURN
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 1:18 BEMUTH RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1315
Mailing Address - Country:US
Mailing Address - Phone:401-861-7711
Mailing Address - Fax:401-421-5710
Practice Address - Street 1:1076 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5760
Practice Address - Country:US
Practice Address - Phone:401-861-7711
Practice Address - Fax:401-421-5710
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42706207RN0300X
RIRI7177207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000251Medicaid
RI7000251Medicaid
A38805Medicare UPIN
RIA38805Medicare UPIN
RI007000252Medicare PIN