Provider Demographics
NPI:1619159910
Name:BENNETT C. YANG, M.D., P.C.
Entity Type:Organization
Organization Name:BENNETT C. YANG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-656-6398
Mailing Address - Street 1:3203 TOWER OAKS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4258
Mailing Address - Country:US
Mailing Address - Phone:301-656-6398
Mailing Address - Fax:301-754-2503
Practice Address - Street 1:3203 TOWER OAKS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4258
Practice Address - Country:US
Practice Address - Phone:301-656-6398
Practice Address - Fax:301-754-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD54936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01250OtherMEDICARE PROVIDER ID
G01250OtherMEDICARE PROVIDER ID