Healthcare Provider Details

I. General information

NPI: 1346999471
Provider Name (Legal Business Name): IAN ANDREW YEAGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 N PALMER RD
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

4494 N PALMER RD
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 908-410-1104
  • Fax:
Mailing address:
  • Phone: 301-295-4000
  • Fax:

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: