MEDICARE: PETER CHIA YEH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	S6099	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208100000X	Physical Medicine & Rehabilitation Physician	0101274306	VA

General Provider Information

NPI Number	:	1073977914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER CHIA YEH

Provider Business Mailing Address
First Line	:	P. O. BOX 715868
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19171-5868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVE
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314
Country	:	US
Telephone Number	:	703-810-5209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	09/16/2022

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