Provider Demographics
NPI:1306066386
Name:MARY A. YUENGERT MD, P.C.
Entity type:Organization
Organization Name:MARY A. YUENGERT MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:YUENGERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-223-7097
Mailing Address - Street 1:11835 FISHING POINT DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2584
Mailing Address - Country:US
Mailing Address - Phone:757-223-7097
Mailing Address - Fax:757-223-7095
Practice Address - Street 1:11835 FISHING POINT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2584
Practice Address - Country:US
Practice Address - Phone:757-223-7097
Practice Address - Fax:757-223-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0103451OtherUNITED HEALTHCARE
VA5785278OtherAETNA
VA17652OtherOPTIMA
VA236108OtherANTHEM BCBS
VA2671966OtherCIGNA
VA1383297OtherFIRST HEALTH
VA839478OtherMAMSI
VA839478OtherMAMSI
VA=========OtherVHN
VA1383297OtherFIRST HEALTH
VA2671966OtherCIGNA