Provider Demographics
NPI:1124067939
Name:YANKE, JONATHAN EDWARD (CPO)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:YANKE
Suffix:
Gender:M
Credentials:CPO
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Mailing Address - Street 1:348 THOMPSON CREEK MALL
Mailing Address - Street 2:BOX 359
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2500
Mailing Address - Country:US
Mailing Address - Phone:410-353-7069
Mailing Address - Fax:866-294-9581
Practice Address - Street 1:844 RITCHIE HWY
Practice Address - Street 2:STE 202
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4137
Practice Address - Country:US
Practice Address - Phone:410-353-7069
Practice Address - Fax:866-294-9581
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-11-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699336200Medicaid
MD4299150001Medicare ID - Type Unspecified