Provider Demographics
NPI:1912006552
Name:GBEMUDU, YVETTE NICHOLSON (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:NICHOLSON
Last Name:GBEMUDU
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:601 NEW CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5821
Mailing Address - Country:US
Mailing Address - Phone:302-655-6187
Mailing Address - Fax:302-655-6606
Practice Address - Street 1:601 NEW CASTLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5821
Practice Address - Country:US
Practice Address - Phone:302-655-6187
Practice Address - Fax:302-655-6606
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG96003Medicare UPIN