Provider Demographics
NPI:1558418301
Name:YANAMADALA, ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:YANAMADALA
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 1:4121 UNION RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1070
Mailing Address - Country:US
Mailing Address - Phone:314-930-3520
Mailing Address - Fax:314-930-3675
Practice Address - Street 1:4121 UNION RD STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1070
Practice Address - Country:US
Practice Address - Phone:314-930-3520
Practice Address - Fax:314-930-3675
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1177172084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205266505Medicaid
MO000093833Medicare UPIN
ILG80860Medicare UPIN
IL501600Medicare ID - Type Unspecified