Provider Demographics
NPI:1760471601
Name:YAO, QIN (MD)
Entity type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:YAO
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908
Practice Address - Country:US
Practice Address - Phone:434-924-2335
Practice Address - Fax:434-982-0796
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012663202080N0001X
OH350788992080N0001X
OH35078899Y208000000X, 2080N0001X
OH35-0788992080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017722010001OtherPA MEDICAID
OH000000526176OtherANTHEM
OH2307775OtherBCMH
OH2307775Medicaid
OH233799OtherBUCKEYE
OH364155OtherWELLCARE
OH7555279OtherAETNA
OH000000217367OtherUNISON
OH233799OtherBUCKEYE
OH000000526176OtherANTHEM
PA1017722010001OtherPA MEDICAID