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General NPI Number Information
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NPI Number | 1104137728
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Entity Type | Individual
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Provider Name | PRADEEPA YOGANATHAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 4717 SAINT ANTOINE ST
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City | DETROIT
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State | MI
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Zip | 48201-1423
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Country | US
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Telephone | 313-577-8932
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Fax |
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Provider Business Mailing Address
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Address Line | 606 WOODVALLEY DR
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City | PITTSBURGH
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State | PA
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Zip | 15238-2135
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Country | US
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Telephone | 716-507-6710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD456953
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 002577
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | MD456953
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207WX0108X
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Taxonomy Name | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
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License Number | MD456953
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301116895
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License Number State | MI
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