Provider Demographics
NPI:1699963298
Name:YILMA, MIMI (MD)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:
Last Name:YILMA
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 1:2204 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5625
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:410-235-8807
Practice Address - Street 1:5517 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3457
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:410-235-8807
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66355103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist