Healthcare Provider Details

I. General information

NPI: 1124179106
Provider Name (Legal Business Name): DAVID L. YEAGER, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 POMFRET ST
PUTNAM CT
06260-1871
US

IV. Provider business mailing address

346 POMFRET ST
PUTNAM CT
06260-1871
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-0815
  • Fax: 860-928-4514
Mailing address:
  • Phone: 860-928-0815
  • Fax: 860-928-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number016964
License Number StateCT

VIII. Authorized Official

Name: DR. DAVID L. YEAGER
Title or Position: DOCTOR
Credential: M.D.
Phone: 860-928-0815