Provider Demographics
NPI:1851752513
Name:YDIPRMC LLC
Entity Type:Organization
Organization Name:YDIPRMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORNMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-944-3351
Mailing Address - Street 1:327 TILGHMAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2015
Mailing Address - Country:US
Mailing Address - Phone:443-944-3351
Mailing Address - Fax:410-334-6352
Practice Address - Street 1:300 SUNBURST HWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2506
Practice Address - Country:US
Practice Address - Phone:443-477-6324
Practice Address - Fax:410-334-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111PMedicare PIN