Provider Demographics
NPI:1184684714
Name:LODI, YAHIA M (MD)
Entity type:Individual
Prefix:
First Name:YAHIA
Middle Name:M
Last Name:LODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABUTACHER
Other - Middle Name:M
Other - Last Name:YAHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:425 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1735
Mailing Address - Country:US
Mailing Address - Phone:607-772-3535
Mailing Address - Fax:607-772-3536
Practice Address - Street 1:46 HARRISON ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2120
Practice Address - Country:US
Practice Address - Phone:607-729-4942
Practice Address - Fax:607-729-7516
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2172962084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02080362Medicaid
NYRB1526Medicare PIN
NYP00407099Medicare PIN