Provider Demographics
NPI:1487768438
Name:YANDILA, REGGINA (DO)
Entity type:Individual
Prefix:DR
First Name:REGGINA
Middle Name:
Last Name:YANDILA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 STATE ROUTE 159
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8207
Mailing Address - Country:US
Mailing Address - Phone:740-779-4700
Mailing Address - Fax:740-779-4798
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:SUITE 150
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-4700
Practice Address - Fax:740-779-4798
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34.008622OtherMEDICAL LICENSE
OH2683305Medicaid
OH2683305Medicaid