Provider Demographics
NPI:1780659300
Name:YEGUDKINA, IRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:YEGUDKINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:484-565-1510
Mailing Address - Fax:484-565-1513
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:484-565-1510
Practice Address - Fax:484-565-1513
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426173207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02015Medicare UPIN
H02015Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE
PA101463977Medicaid