Healthcare Provider Details

I. General information

NPI: 1457374423
Provider Name (Legal Business Name): RONALD S YEARWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD STE 110
LYONS NY
14489-9112
US

IV. Provider business mailing address

1519 NYE RD STE 110
LYONS NY
14489-9112
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax: 315-946-7068
Mailing address:
  • Phone: 315-946-5722
  • Fax: 315-946-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number278086
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: