Provider Demographics
NPI:1992760110
Name:GANCHORRE, YOLANDA (MD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:GANCHORRE
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 1:12300 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2914
Mailing Address - Country:US
Mailing Address - Phone:216-587-8350
Mailing Address - Fax:216-587-8646
Practice Address - Street 1:12300 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2914
Practice Address - Country:US
Practice Address - Phone:216-587-8350
Practice Address - Fax:216-587-8646
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032891G2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4007271OtherAETNA
OH740990OtherBUCKEYE HEALTH PLAN
OH000000216104OtherUNICARE
OH0215494Medicaid
OH351179OtherWELLCARE HEALTH PLAN
OH000000216104OtherANTHEM BLUE CROSS
OH000000216104OtherANTHEM BLUE CROSS
OH0215494Medicaid
OHP00767628Medicare PIN
OH0459887Medicare PIN