Provider Demographics
NPI:1609882000
Name:YETURU, BHASKAR R (MD)
Entity Type:Individual
Prefix:
First Name:BHASKAR
Middle Name:R
Last Name:YETURU
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 1:8712 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4821
Mailing Address - Country:US
Mailing Address - Phone:718-426-4800
Mailing Address - Fax:
Practice Address - Street 1:8712 58TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4821
Practice Address - Country:US
Practice Address - Phone:718-426-4800
Practice Address - Fax:718-651-9284
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587584Medicaid
I12828Medicare UPIN
NY02587584Medicaid