Healthcare Provider Details

I. General information

NPI: 1881686616
Provider Name (Legal Business Name): FRED YEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NHCNE GROTON
GROTON CT
06340
US

IV. Provider business mailing address

86 SCHOOL ST
GROTON CT
06340-3941
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-6481
  • Fax:
Mailing address:
  • Phone: 240-731-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0061109
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15165
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0061109
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54505
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: