Healthcare Provider Details

I. General information

NPI: 1750017570
Provider Name (Legal Business Name): DAVID YEAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 SAUNDERS WAY
GLEN BURNIE MD
21061-4328
US

IV. Provider business mailing address

1603 SAUNDERS WAY
GLEN BURNIE MD
21061-4328
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-0820
  • Fax:
Mailing address:
  • Phone: 410-694-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19754
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: