Provider Demographics
NPI:1417489253
Name:GE, YIDI (MD)
Entity Type:Individual
Prefix:DR
First Name:YIDI
Middle Name:
Last Name:GE
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 1:850 N MAIN STREET EXT STE 1A3
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2466
Mailing Address - Country:US
Mailing Address - Phone:203-269-4353
Mailing Address - Fax:203-269-4606
Practice Address - Street 1:850 N MAIN STREET EXT STE 1A3
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2466
Practice Address - Country:US
Practice Address - Phone:203-269-4353
Practice Address - Fax:203-269-4606
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65274207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program