Provider Demographics
NPI:1851499784
Name:YERON, RICHARD GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GEORGE
Last Name:YERON
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 1:1090 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-3967
Mailing Address - Country:US
Mailing Address - Phone:301-662-0757
Mailing Address - Fax:301-662-0725
Practice Address - Street 1:1090 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-3967
Practice Address - Country:US
Practice Address - Phone:301-662-0757
Practice Address - Fax:301-662-0725
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41717207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD153061500Medicaid
MD153061500Medicaid
E93212Medicare UPIN