Provider Demographics
NPI:1306891924
Name:YAMPOLSKY, IGOR M (MD)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:M
Last Name:YAMPOLSKY
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 1:1650 VALLEY CENTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2344
Mailing Address - Country:US
Mailing Address - Phone:484-884-4436
Mailing Address - Fax:484-884-4444
Practice Address - Street 1:1600 HANOVER AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2408
Practice Address - Country:US
Practice Address - Phone:610-740-3302
Practice Address - Fax:610-740-3413
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4256342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1333007OtherHIGHMARK BLUE SHIELD
PA50053669OtherCAPITAL BLUE CROSS
PA1014345360001Medicaid
PA092226Medicare ID - Type Unspecified
PAG40075Medicare UPIN