Provider Demographics
NPI:1538305560
Name:OKHOTINA, YULIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:YULIA
Middle Name:A
Last Name:OKHOTINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-372-8044
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:950 N WYOMISSING BLVD # A
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1784
Practice Address - Country:US
Practice Address - Phone:610-898-2400
Practice Address - Fax:610-378-7839
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102690568Medicaid
PA237006Medicare PIN