Provider Demographics
NPI:1134363427
Name:MARICICH, YURI (MD)
Entity type:Individual
Prefix:
First Name:YURI
Middle Name:
Last Name:MARICICH
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 1:977 SEMINOLE TRL
Mailing Address - Street 2:#357
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2824
Mailing Address - Country:US
Mailing Address - Phone:206-369-6014
Mailing Address - Fax:
Practice Address - Street 1:977 SEMINOLE TRL
Practice Address - Street 2:#357
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2824
Practice Address - Country:US
Practice Address - Phone:206-369-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251697208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01106897Medicare PIN
VAVV6093AMedicare PIN