Provider Demographics
NPI:1043531403
Name:TAL, YOAV J (MD)
Entity type:Individual
Prefix:DR
First Name:YOAV
Middle Name:J
Last Name:TAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3606 ASTORIA RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1403
Mailing Address - Country:US
Mailing Address - Phone:215-518-5196
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-4306
Practice Address - Country:US
Practice Address - Phone:302-623-0188
Practice Address - Fax:302-733-5640
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0010572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1043531403Medicaid
DE1043531403Medicaid