Provider Demographics
NPI:1871571109
Name:YAROSH, SCOTT MERRILL (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MERRILL
Last Name:YAROSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 UNIVERISTY AVENUE WEST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-955-6255
Mailing Address - Fax:651-493-4178
Practice Address - Street 1:1600 UNIVERSITY AVENUE WEST
Practice Address - Street 2:SUITE 205
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-955-6255
Practice Address - Fax:651-493-4178
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN322602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN36A90YAOtherBCBS OF MN
MN1510003OtherMEDICA
MN934795000Medicaid
MN260001237Medicare ID - Type Unspecified
MN1510003OtherMEDICA