Provider Demographics
NPI:1619963162
Name:YU, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 ROCK SPRING DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1154
Mailing Address - Country:US
Mailing Address - Phone:301-530-8300
Mailing Address - Fax:
Practice Address - Street 1:6500 ROCK SPRING DR STE 105
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-530-8300
Practice Address - Fax:301-530-4638
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063201207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25836Medicare UPIN
MD017468D39Medicare ID - Type Unspecified