Provider Demographics
NPI:1386643450
Name:YANOVICH, SAUL
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:
Last Name:YANOVICH
Suffix:
Gender:M
Credentials:
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 62602
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2602
Mailing Address - Country:US
Mailing Address - Phone:410-328-6841
Mailing Address - Fax:410-328-2578
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6841
Practice Address - Fax:410-328-2578
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC32562207RH0003X
MDD62798207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD025503301Medicaid
MDS053-0052OtherCAREFIRST - REGIONAL
DE1386643450Medicaid
MD608539-02 & 03OtherCAREFIRST - MARYLAND
DE1386643450Medicaid
MDP00608765Medicare PIN
MDS053-0052OtherCAREFIRST - REGIONAL