Provider Demographics
NPI:1831107325
Name:YAGODICH, MARK CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:YAGODICH
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 1:39 RITTENHOUSE PL
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2209
Mailing Address - Country:US
Mailing Address - Phone:610-642-8837
Mailing Address - Fax:610-642-1607
Practice Address - Street 1:39 RITTENHOUSE PL
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2209
Practice Address - Country:US
Practice Address - Phone:610-642-8837
Practice Address - Fax:610-642-1607
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004026L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7476158OtherAETNA
PA0018222940001Medicaid
PA0981588000OtherINDEPENDENCE BLUE CROSS
PA7476158OtherAETNA
PA870915PC6Medicare PIN