Provider Demographics
NPI:1588661508
Name:YADALAM, KASHINATH GANGADHARA (MD)
Entity type:Individual
Prefix:DR
First Name:KASHINATH
Middle Name:GANGADHARA
Last Name:YADALAM
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 1:3712 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2571
Mailing Address - Country:US
Mailing Address - Phone:337-474-5863
Mailing Address - Fax:337-656-2564
Practice Address - Street 1:1 LAKESHORE DR
Practice Address - Street 2:SUITE 1695
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70629-0100
Practice Address - Country:US
Practice Address - Phone:337-564-6405
Practice Address - Fax:337-656-2563
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-04-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
LA08664R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry