Provider Demographics
NPI:1770531436
Name:YATHIRAJ, DUMMI P (MD)
Entity type:Individual
Prefix:
First Name:DUMMI
Middle Name:P
Last Name:YATHIRAJ
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 1:311 NILLES RD
Mailing Address - Street 2:STE C
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2621
Mailing Address - Country:US
Mailing Address - Phone:513-829-2124
Mailing Address - Fax:513-829-2125
Practice Address - Street 1:311 NILLES RD
Practice Address - Street 2:STE C
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2621
Practice Address - Country:US
Practice Address - Phone:513-829-2124
Practice Address - Fax:513-829-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036943207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287863Medicaid
OHA74980Medicare UPIN
OH110132978Medicare PIN
OH0403941Medicare PIN