Provider Demographics
NPI:1245208289
Name:YINDRA, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:YINDRA
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 1:180 CHURCH HILL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEEDS
Mailing Address - State:ME
Mailing Address - Zip Code:04263-3418
Mailing Address - Country:US
Mailing Address - Phone:207-524-3501
Mailing Address - Fax:207-524-2459
Practice Address - Street 1:11 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259-7035
Practice Address - Country:US
Practice Address - Phone:207-524-3501
Practice Address - Fax:207-933-9645
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD11092207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1245208289Medicaid
NH32000252Medicaid
ME01520703Medicare PIN
ME01520702Medicare PIN
ME015207Medicare PIN
ME1245208289Medicaid
MEP01035717Medicare PIN
ME01520705Medicare PIN
ME01520704Medicare PIN