Provider Demographics
NPI:1528048832
Name:YAO, LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 FAIRMONT AVE
Mailing Address - Street 2:APT 901
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6046
Mailing Address - Country:US
Mailing Address - Phone:703-287-4189
Mailing Address - Fax:703-448-1807
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5146
Practice Address - Country:US
Practice Address - Phone:301-733-1477
Practice Address - Fax:301-733-7758
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00558752085R0202X
CAG682202085R0202X
DEC100059122085R0202X
DCMD307042085R0202X
HIMD126982085R0202X
OH35077798Y2085R0202X
PAMD071072L2085R0202X
TXL20632085R0202X
VA01012263282085R0202X
CO447412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7206976Medicaid
VA7208031Medicaid
WV7200758000Medicaid
VA7206887Medicaid
PA0019552720001Medicaid
DE0001092201Medicaid
MD192M231FMedicare PIN
VA7206887Medicaid
DE0001092201Medicaid
VA7206976Medicaid
MD193M134FMedicare PIN
F38983Medicare UPIN
PA0019552720001Medicaid
TX89951RMedicare PIN
OH4023344Medicare PIN
DE009140M06Medicare PIN