Provider Demographics
NPI:1588642052
Name:YESHMAN, LARRY (DPM)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:YESHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50432
Mailing Address - Street 2:CLAIMNET
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-0015
Mailing Address - Country:US
Mailing Address - Phone:508-965-3335
Mailing Address - Fax:508-763-4303
Practice Address - Street 1:26 SHANNON WAY
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1182
Practice Address - Country:US
Practice Address - Phone:508-763-4025
Practice Address - Fax:508-763-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA428481213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0341347Medicaid
MA001617OtherTUFTS
MA0341347Medicaid