Healthcare Provider Details

I. General information

NPI: 1780659300
Provider Name (Legal Business Name): IRINA YEGUDKINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1510
  • Fax: 484-565-1513
Mailing address:
  • Phone: 484-565-1510
  • Fax: 484-565-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD426173
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD426173
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: