Healthcare Provider Details

I. General information

NPI: 1306993316
Provider Name (Legal Business Name): PRAMOD K YADHATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 KIRKWOOD HWY SUITE 200
WILMINGTON DE
19808-5123
US

IV. Provider business mailing address

PO BOX 3012
WILMINGTON DE
19804-0012
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-2585
  • Fax: 302-998-3394
Mailing address:
  • Phone: 302-224-5678
  • Fax: 302-224-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC10005008
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: