Provider Demographics
NPI:1881634491
Name:YU, WILLIE M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:M
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6550 MERCANTILE DR. EAST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8655
Mailing Address - Country:US
Mailing Address - Phone:301-668-0888
Mailing Address - Fax:301-668-0999
Practice Address - Street 1:6550 MERCANTILE DR E
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7655
Practice Address - Country:US
Practice Address - Phone:301-668-0888
Practice Address - Fax:301-668-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00534892081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD158300000Medicaid
MDG31968Medicare UPIN
MD158300000Medicaid