Provider Demographics
NPI:1740565506
Name:UNIVERSAL HEALTHCARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:UNIVERSAL HEALTHCARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:M
Authorized Official - Last Name:YIENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-357-0342
Mailing Address - Street 1:1050 KEY PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4053
Mailing Address - Country:US
Mailing Address - Phone:301-846-2273
Mailing Address - Fax:301-620-2273
Practice Address - Street 1:1050 KEY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4053
Practice Address - Country:US
Practice Address - Phone:301-846-2273
Practice Address - Fax:301-620-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047951208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty