Provider Demographics
NPI:1821369935
Name:DR. MARIA YIASSEMIDES, P.A.
Entity Type:Organization
Organization Name:DR. MARIA YIASSEMIDES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YIASSEMIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-628-0010
Mailing Address - Street 1:3421 SWEET AIR RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1812
Mailing Address - Country:US
Mailing Address - Phone:410-628-0010
Mailing Address - Fax:410-628-4837
Practice Address - Street 1:3421 SWEET AIR RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1812
Practice Address - Country:US
Practice Address - Phone:410-628-0010
Practice Address - Fax:410-628-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU75443Medicare UPIN