Basic Information
| Provider Information | |||||||||
| NPI: | 1285624486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAROLD | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5104 W VIEW CT | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234353505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576865723 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 GODWIN BLVD | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101058808 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 5713552 | 05 | VA | MEDICAID |