Provider Demographics
NPI:1437109659
Name:PERSIDSKY, YURI (MD, PHD)
Entity Type:Individual
Prefix:MR
First Name:YURI
Middle Name:
Last Name:PERSIDSKY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:MR
Other - First Name:IORI
Other - Middle Name:V
Other - Last Name:PERSIDSKII
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-4353
Mailing Address - Fax:215-707-9580
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:TEMPLE PATHOLOGY ASSOCIATES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-4353
Practice Address - Fax:215-707-9580
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434703207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557547Medicaid
NE47078557547Medicaid
NE274236Medicare ID - Type Unspecified