Provider Demographics
NPI:1427143957
Name:TRNKA, YVONA M (MD)
Entity type:Individual
Prefix:
First Name:YVONA
Middle Name:M
Last Name:TRNKA
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 1:147 MILK STREET
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:
Practice Address - Street 1:133 BROOKLINE AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2523
Practice Address - Country:US
Practice Address - Phone:617-421-1380
Practice Address - Fax:617-421-1303
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40734207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003082OtherNEIGHBORHOOD HEALTH PLAN
MA3179605Medicaid
MAM167OtherHARVARD PILGRIM
MA729764OtherTUFTS HEALTH PLAN
MAE05238OtherBLUE CROSS
MAP00074246OtherMEDICARE RAILROAD
MA3227393-002OtherCIGNA
MAE05238OtherBLUE CROSS
MAE05238Medicare PIN