Provider Demographics
NPI:1699700187
Name:YATHAM, PADMAJA (MD)
Entity type:Individual
Prefix:DR
First Name:PADMAJA
Middle Name:
Last Name:YATHAM
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 1:7000 SW 97TH AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1492
Mailing Address - Country:US
Mailing Address - Phone:786-780-1800
Mailing Address - Fax:786-780-2500
Practice Address - Street 1:7000 SW 97TH AVE STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1492
Practice Address - Country:US
Practice Address - Phone:786-780-1800
Practice Address - Fax:786-780-2500
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98251207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1070341OtherCARE PLUS
FL95717OtherBCBS
FL6287092OtherCIGNA
FL9788253OtherAETNA
FL409417OtherWELLCARE
FL409417OtherWELLCARE
FL6287092OtherCIGNA