Healthcare Provider Details

I. General information

NPI: 1659359560
Provider Name (Legal Business Name): YESHWANT GOPAL PHADKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE SUITE 106
INDIANA PA
15701-3501
US

IV. Provider business mailing address

1265 WAYNE AVE SUITE 106
INDIANA PA
15701-3501
US

V. Phone/Fax

Practice location:
  • Phone: 724-349-6677
  • Fax: 724-349-6678
Mailing address:
  • Phone: 724-349-6677
  • Fax: 724-349-6678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberMD037054L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD037054-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: