Provider Demographics
NPI:1922020981
Name:KAMATH, VODERBET C (MD)
Entity type:Individual
Prefix:
First Name:VODERBET
Middle Name:C
Last Name:KAMATH
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:PO BOX 8051
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-469-1903
Mailing Address - Fax:509-469-1905
Practice Address - Street 1:307 S 12TH AVE
Practice Address - Street 2:STE 19
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3148
Practice Address - Country:US
Practice Address - Phone:509-469-1446
Practice Address - Fax:509-469-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045883207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1200211Medicaid
WAG8858171Medicare PIN
WA1200211Medicaid