Provider Demographics
NPI:1083655427
Name:JONNA, YADAGIRI R (MD)
Entity Type:Individual
Prefix:
First Name:YADAGIRI
Middle Name:R
Last Name:JONNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YADAGIRI
Other - Middle Name:NR
Other - Last Name:JONNALAGADLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:303 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2503
Mailing Address - Country:US
Mailing Address - Phone:260-919-3452
Mailing Address - Fax:260-919-3565
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2503
Practice Address - Country:US
Practice Address - Phone:260-919-3452
Practice Address - Fax:260-919-3565
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049311A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100198920AMedicaid
IN100198920AMedicaid
IN234760012Medicare PIN
IN911080D5Medicare PIN