Healthcare Provider Details

I. General information

NPI: 1275519605
Provider Name (Legal Business Name): PATRICK ALAN YEAGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HAWKINS POINT RD
BALTIMORE MD
21226-1797
US

IV. Provider business mailing address

2401 HAWKINS POINT RD
BALTIMORE MD
21226-1797
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-7506
  • Fax: 410-636-7868
Mailing address:
  • Phone: 410-636-7506
  • Fax: 410-636-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: