Provider Demographics
NPI:1457569006
Name:YODER, NICOLE DENISE GRAY (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE GRAY
Last Name:YODER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1107
Mailing Address - Country:US
Mailing Address - Phone:610-954-3890
Mailing Address - Fax:610-954-3046
Practice Address - Street 1:709 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1107
Practice Address - Country:US
Practice Address - Phone:610-954-3890
Practice Address - Fax:610-954-3046
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013307207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine