Provider Demographics
NPI:1871884288
Name:YADWADKAR, TANUSHREE SUBHASH (MD)
Entity type:Individual
Prefix:
First Name:TANUSHREE
Middle Name:SUBHASH
Last Name:YADWADKAR
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:
Practice Address - Street 1:2840 E SKYLINE DR STE 230
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8005
Practice Address - Country:US
Practice Address - Phone:520-324-1214
Practice Address - Fax:520-324-1281
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60105207R00000X
OH35.124568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005762Medicaid
OH35.124568OtherOHIO LICENSE