Provider Demographics
NPI:1477592228
Name:GAO, MICHAEL YUAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YUAN
Last Name:GAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YUAN
Other - Middle Name:
Other - Last Name:GAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:49 VERONICA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6802
Mailing Address - Country:US
Mailing Address - Phone:732-246-0495
Mailing Address - Fax:732-246-0503
Practice Address - Street 1:49 VERONICA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6802
Practice Address - Country:US
Practice Address - Phone:732-246-0495
Practice Address - Fax:732-246-0503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07601400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038091Medicaid
I18863Medicare UPIN
084396A0WMedicare ID - Type Unspecified