Provider Demographics
NPI:1043256423
Name:YAMRAJ, BHAWAN (MD)
Entity Type:Individual
Prefix:
First Name:BHAWAN
Middle Name:
Last Name:YAMRAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-796-3029
Mailing Address - Fax:606-796-6221
Practice Address - Street 1:645 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1704
Practice Address - Country:US
Practice Address - Phone:606-474-0669
Practice Address - Fax:502-227-4965
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086408207Q00000X
KY38038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003784Medicaid
KY64056633Medicaid
OH2574923Medicaid
KY3400336Medicare PIN
OH4194133Medicare PIN
KY0351452Medicare PIN
KY0307654Medicare PIN
KY0264260Medicare ID - Type Unspecified
KY64056633Medicaid
OH2574923Medicaid
WV3810003784Medicaid
KY0632950Medicare PIN
KY3403634Medicare PIN
OH4194131Medicare PIN
KY0264260Medicare PIN
OH4194134Medicare PIN
OH4194136Medicare PIN
KY0586625Medicare PIN