Provider Demographics
NPI:1780698852
Name:YELOVICH, MAUREEN L (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:YELOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1743
Mailing Address - Country:US
Mailing Address - Phone:610-644-8069
Mailing Address - Fax:610-644-6736
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-644-8069
Practice Address - Fax:610-644-6736
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA027311E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYE155533Medicare ID - Type Unspecified
PWB40129Medicare UPIN