Provider Demographics
NPI:1104408087
Name:YAMADA, KELSEY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:YAMADA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JIRO
Other - Last Name:YAMADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8521
Practice Address - Fax:717-531-5068
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD489886208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist