Provider Demographics
NPI:1053375832
Name:YERNENI, MADHAVI (MD)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:YERNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 EAST AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5299
Mailing Address - Country:US
Mailing Address - Phone:401-725-4700
Mailing Address - Fax:401-725-4740
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5299
Practice Address - Country:US
Practice Address - Phone:401-725-4700
Practice Address - Fax:401-725-4740
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI21727-3OtherBLUE SHIELD OF RI
RI400240OtherBLUE CHIP OF RHODE ISLAND
RI9025203Medicaid
RI400240OtherBLUE CHIP OF RHODE ISLAND
G31268Medicare UPIN