Provider Demographics
NPI:1942383336
Name:TAGOURI, YAHIA M (MD)
Entity Type:Individual
Prefix:
First Name:YAHIA
Middle Name:M
Last Name:TAGOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8725 LOCH RAVEN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21284
Mailing Address - Country:US
Mailing Address - Phone:410-828-8100
Mailing Address - Fax:410-882-3310
Practice Address - Street 1:2500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:410-828-8100
Practice Address - Fax:410-882-3310
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050883174400000X
DCD0050883207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD796460900Medicaid
MD537LMedicare PIN