Provider Demographics
NPI:1124207352
Name:TODDYWALLA, YASODAH (MD)
Entity Type:Individual
Prefix:
First Name:YASODAH
Middle Name:
Last Name:TODDYWALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YASODAH
Other - Middle Name:
Other - Last Name:JAYAMOHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4138
Mailing Address - Fax:859-258-4796
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4138
Practice Address - Fax:859-258-4796
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57012932207ZB0001X
KY38652207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100046740Medicaid