Provider Demographics
NPI:1053452508
Name:YADATI, SANTHARAM (MD)
Entity type:Individual
Prefix:
First Name:SANTHARAM
Middle Name:
Last Name:YADATI
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 1:436 AMHERST ST
Mailing Address - Street 2:STE 101
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1276
Mailing Address - Country:US
Mailing Address - Phone:603-577-3003
Mailing Address - Fax:603-577-2243
Practice Address - Street 1:436 AMHERST ST STE 101
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1276
Practice Address - Country:US
Practice Address - Phone:603-627-4764
Practice Address - Fax:603-577-9595
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH68492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009846Medicaid
NHNH9846Medicare ID - Type UnspecifiedMEDICARE
NHE33522Medicare UPIN