Provider Demographics
NPI:1851332605
Name:YEVICH-TUNSTALL, INIA I (MD)
Entity type:Individual
Prefix:DR
First Name:INIA
Middle Name:I
Last Name:YEVICH-TUNSTALL
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 1:8136 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE A205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1851
Mailing Address - Country:US
Mailing Address - Phone:703-866-2881
Mailing Address - Fax:703-866-2884
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:SUITE A205
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1851
Practice Address - Country:US
Practice Address - Phone:703-866-2881
Practice Address - Fax:703-866-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043927207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE52294Medicare UPIN
VA622269Medicare PIN