Provider Demographics
NPI:1073892519
Name:MANOHAR YEDULAPURAM MD PA
Entity Type:Organization
Organization Name:MANOHAR YEDULAPURAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITALIST
Authorized Official - Prefix:
Authorized Official - First Name:MANOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YEDULAPURAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-618-1020
Mailing Address - Street 1:7501 VALLEEN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3977
Mailing Address - Country:US
Mailing Address - Phone:972-618-1020
Mailing Address - Fax:
Practice Address - Street 1:7501 VALLEEN DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3977
Practice Address - Country:US
Practice Address - Phone:972-618-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1411208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty