Provider Demographics
NPI:1841361086
Name:HANCOCK, YOLANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:YOLANDRA
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14526 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3040
Mailing Address - Country:US
Mailing Address - Phone:301-304-4939
Mailing Address - Fax:301-327-1749
Practice Address - Street 1:14526 CHURCH ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3040
Practice Address - Country:US
Practice Address - Phone:301-304-4939
Practice Address - Fax:301-327-1749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
DCMD035513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA62727379Medicaid
MD343671300Medicaid
DC5888180Medicaid