Provider Demographics
NPI:1689733099
Name:YDIPRMC LLC
Entity Type:Organization
Organization Name:YDIPRMC LLC
Other - Org Name:YOUR DOCS IN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORNMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-944-3351
Mailing Address - Street 1:327 TILGHMAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2015
Mailing Address - Country:US
Mailing Address - Phone:443-944-3351
Mailing Address - Fax:410-334-6352
Practice Address - Street 1:8163 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7145
Practice Address - Country:US
Practice Address - Phone:410-822-0200
Practice Address - Fax:410-820-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20235706207P00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11ZMYOOtherBLUE CROSS GROUP NUMBER
DE1000038586Medicaid
MD2145659OtherMAMSI GROUP PROV.NUMBER
MDDD9023OtherRAILROAD MEDICARE GRP NUM
MD7603709OtherAETNA GROUP PROVIDER NUMB
MD408316400Medicaid
DC3780OtherBLUE CROSS DC GROUP NUMBE
MD5568160003Medicare NSC
MD2145659OtherMAMSI GROUP PROV.NUMBER
MD7603709OtherAETNA GROUP PROVIDER NUMB
MDDD9023OtherRAILROAD MEDICARE GRP NUM