Provider Demographics
NPI:1386651099
Name:YACOUB, CARL RAMSES (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:RAMSES
Last Name:YACOUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1423 CAPITOL TRL STE 1114
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5709
Mailing Address - Country:US
Mailing Address - Phone:302-996-9010
Mailing Address - Fax:302-996-9027
Practice Address - Street 1:1423 CAPITOL TRL STE 1114
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5709
Practice Address - Country:US
Practice Address - Phone:302-996-9010
Practice Address - Fax:302-996-9027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00046262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001164401Medicaid
DE0001164401Medicaid
00A913C32Medicare PIN