Provider Demographics
NPI:1760457006
Name:YEO, BRIAN TRIVEDI (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:TRIVEDI
Last Name:YEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BYUNG
Other - Middle Name:TAIK
Other - Last Name:YEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 SOUTH UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078
Mailing Address - Country:US
Mailing Address - Phone:410-939-0061
Mailing Address - Fax:410-939-4975
Practice Address - Street 1:801 SOUTH UNION AVENUE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078
Practice Address - Country:US
Practice Address - Phone:410-939-0061
Practice Address - Fax:410-939-4975
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015152207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
9439BTMedicare ID - Type Unspecified
B69862Medicare UPIN