Provider Demographics
NPI:1497816862
Name:MAGETO, YOLANDA N (MD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:N
Last Name:MAGETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:NYABOKE
Other - Last Name:MAGETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3410 WORTH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2003
Mailing Address - Country:US
Mailing Address - Phone:802-820-6856
Mailing Address - Fax:214-820-5094
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:802-820-6856
Practice Address - Fax:214-820-5094
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011355207RC0200X, 207RP1001X
TXJ2174207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060VT011355Medicaid
VT10138313Medicaid
TX105919801Medicaid
TX105919801Medicaid
F83526Medicare UPIN