MEDICARE: DR. GABRIEL J YANDAM M.D., F.A.C.O.G.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35070595Y	OH

General Provider Information

NPI Number	:	1811952997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL J YANDAM M.D., F.A.C.O.G.

Provider Business Mailing Address
First Line	:	656 CHESTNUT ST
Second Line	:	P.O. BOX 910
City	:	COSHOCTON
State	:	OH
Zip	:	43812-1211
Country	:	US
Telephone Number	:	740-623-2402
Fax Number	:	740-623-2405

Provider Business Practice Location Address
First Line	:	656 CHESTNUT ST
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-1211
Country	:	US
Telephone Number	:	740-623-2402
Fax Number	:	740-623-2405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	04/15/2020

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