Healthcare Provider Details

I. General information

NPI: 1609928183
Provider Name (Legal Business Name): DAVID L. YEAGER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
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 Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number001409
License Number StateCT

VIII. Authorized Official

Name: MRS. JEANNE F. BEDARD
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 860-928-0815