Provider Demographics
NPI:1194895284
Name:YIASSEMIDES, MARIA (DC)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:YIASSEMIDES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 SWEET AIR RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1812
Mailing Address - Country:US
Mailing Address - Phone:410-628-0010
Mailing Address - Fax:410-628-4837
Practice Address - Street 1:3421 SWEET AIR RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1812
Practice Address - Country:US
Practice Address - Phone:410-628-0010
Practice Address - Fax:410-628-4837
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5265780OtherAETNA NON-HMO
MDLT48OtherBLUECROSSBLUESHIELD
MD350045858OtherRAILROAD MEDICARE
MD522253872OtherTAX ID
MD4400252OtherUNITED HEALTH CARE
MD2145698OtherAETNA HMO
DCT619OtherBLUECROSSBLUESHIELD
MD294856OtherMAMSI. ALLIANCE, OPT. CH.
MD5265780OtherAETNA NON-HMO
MD2145698OtherAETNA HMO