Provider Demographics
NPI:1194880906
Name:OTTAVIANO, YVONNE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:LYNN
Last Name:OTTAVIANO
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 1:109 LONGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2119
Mailing Address - Country:US
Mailing Address - Phone:410-464-1658
Mailing Address - Fax:443-777-8405
Practice Address - Street 1:9103 FRANKLING SQUARE DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:443-777-7147
Practice Address - Fax:443-777-8405
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40850207RX0202X
PAMD482883207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD776471500Medicaid
MDD40850OtherMD STATE LICENSE