Provider Demographics
NPI:1912559782
Name:YURCHENKO, TARAS (PA-C)
Entity Type:Individual
Prefix:
First Name:TARAS
Middle Name:
Last Name:YURCHENKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3309
Mailing Address - Country:US
Mailing Address - Phone:302-674-4627
Mailing Address - Fax:302-674-4628
Practice Address - Street 1:1100 FORREST AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3309
Practice Address - Country:US
Practice Address - Phone:302-674-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical