Provider Demographics
NPI:1790866812
Name:PUSHKIN, YAACOV (MD)
Entity Type:Individual
Prefix:DR
First Name:YAACOV
Middle Name:
Last Name:PUSHKIN
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 1:5213 HICKORY PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2617
Mailing Address - Country:US
Mailing Address - Phone:804-237-8030
Mailing Address - Fax:804-237-8028
Practice Address - Street 1:5213 HICKORY PARK DR STE A
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2617
Practice Address - Country:US
Practice Address - Phone:804-237-8030
Practice Address - Fax:804-237-8028
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010475462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010101000 541581185Medicaid
VAF59099Medicare UPIN
VA010101000 541581185Medicaid