Provider Demographics
NPI:1700929809
Name:CHEPURU, YADAGIRI (MD)
Entity Type:Individual
Prefix:
First Name:YADAGIRI
Middle Name:
Last Name:CHEPURU
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 1:984 N BROADWAY
Mailing Address - Street 2:STE 500A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1322
Mailing Address - Country:US
Mailing Address - Phone:914-963-0223
Mailing Address - Fax:914-963-4939
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:STE 500A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-963-0223
Practice Address - Fax:914-963-4939
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1411212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00582738Medicaid
NYB14297Medicare UPIN
NY41A551Medicare PIN