Provider Demographics
NPI:1518957307
Name:MAMONLUK-CHUA, MARIBEL YAP (MD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:YAP
Last Name:MAMONLUK-CHUA
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 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE008
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-526-3897
Mailing Address - Fax:202-526-7723
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE008
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-526-3897
Practice Address - Fax:202-526-7723
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 037327207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0403203 00Medicaid
VA1518957307Medicaid
DC0403203 00Medicaid