Basic Information
| Provider Information | |||||||||
| NPI: | 1831141852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YARIAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 PORTLAND STREET SUITE 2A | ||||||||
| Address2: | |||||||||
| City: | SOUTH BERWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039081203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073849212 | ||||||||
| FaxNumber: | 2073842008 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 PORTLAND ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | SOUTH BERWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039081203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073849212 | ||||||||
| FaxNumber: | 2073842008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 014669 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 273840099 | 05 | ME | MEDICAID |