Healthcare Provider Details

I. General information

NPI: 1053452508
Provider Name (Legal Business Name): SANTHARAM YADATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 AMHERST ST STE 101
NASHUA NH
03063-1276
US

IV. Provider business mailing address

436 AMHERST ST STE 101
NASHUA NH
03063-1276
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-4764
  • Fax: 603-577-9595
Mailing address:
  • Phone: 603-577-3003
  • Fax: 603-577-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6849
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: