Provider Demographics
NPI:1205849445
Name:JADHAV, YASHODEEP P (MD,MPH)
Entity type:Individual
Prefix:DR
First Name:YASHODEEP
Middle Name:P
Last Name:JADHAV
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 FOX GLEN LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-791-1145
Mailing Address - Fax:254-743-0054
Practice Address - Street 1:1901 S FIRST STREET
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-9976
Practice Address - Country:US
Practice Address - Phone:254-743-0651
Practice Address - Fax:254-743-0054
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4188272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFT303ZMedicare PIN
CAFS963ZMedicare PIN