Provider Demographics
NPI:1811952997
Name:YANDAM, GABRIEL J (MD, FACOG)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:J
Last Name:YANDAM
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:LA FEMME
Other - Middle Name:
Other - Last Name:OB/GYN LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:656 CHESTNUT ST
Mailing Address - Street 2:P.O. BOX 910
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1211
Mailing Address - Country:US
Mailing Address - Phone:740-623-2402
Mailing Address - Fax:740-623-2405
Practice Address - Street 1:656 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1211
Practice Address - Country:US
Practice Address - Phone:740-623-2402
Practice Address - Fax:740-623-2405
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070595Y174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHYA0816913Medicare PIN
OHG42835Medicare UPIN