Provider Demographics
NPI:1023297587
Name:GOYAL, YATISH (MD)
Entity type:Individual
Prefix:DR
First Name:YATISH
Middle Name:
Last Name:GOYAL
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 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-725-7277
Mailing Address - Fax:330-725-7266
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-725-7277
Practice Address - Fax:330-725-7266
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074511G207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138261Medicaid
OH000000325151OtherBLUE CROSS BLUE SHIELD
OH000000325151OtherBLUE CROSS BLUE SHIELD
OH2138261Medicaid