Provider Demographics
NPI:1578507893
Name:YANAMADULA, DINASH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DINASH
Middle Name:KUMAR
Last Name:YANAMADULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DINASH
Other - Middle Name:KUMAR
Other - Last Name:YANAMADULA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:237 N BREAD ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1238
Mailing Address - Country:US
Mailing Address - Phone:386-316-0850
Mailing Address - Fax:
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:386-316-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 73395208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86402Medicare UPIN
57645Medicare ID - Type Unspecified