Provider Demographics
NPI:1801849039
Name:YAMADA, BRIAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:YAMADA
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 1:19 WEST AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6049
Mailing Address - Country:US
Mailing Address - Phone:518-583-0111
Mailing Address - Fax:518-583-2426
Practice Address - Street 1:19 WEST AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6049
Practice Address - Country:US
Practice Address - Phone:518-583-0111
Practice Address - Fax:518-583-2426
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239876208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02792423Medicaid
NY02792423Medicaid
NYJ400099709Medicare PIN