Healthcare Provider Details

I. General information

NPI: 1457511883
Provider Name (Legal Business Name): COLLEEN K. YAVAROW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 03/13/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 LONG SANDS RD
YORK ME
03909-1158
US

IV. Provider business mailing address

127 LONG SANDS RD
YORK ME
03909-1158
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-3777
  • Fax:
Mailing address:
  • Phone: 207-351-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberLT4382
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDO2579
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: