Provider Demographics
NPI:1154549251
Name:YAMAMOTO, KATHRYN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYNN
Last Name:YAMAMOTO
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:10755 FALLS RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4515
Practice Address - Country:US
Practice Address - Phone:410-583-2777
Practice Address - Fax:410-583-2782
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD292222207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00430508OtherRAILROAD
MD369171300Medicaid
MD413046400Medicaid
MD413046400Medicaid
MD129666YVZMedicare PIN
MD489PR319Medicare PIN
MD129666ZDDBMedicare PIN