Healthcare Provider Details

I. General information

NPI: 1194053702
Provider Name (Legal Business Name): NEWMAN M YEILDING III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 EDGEWOOD RD
ARDMORE PA
19003-2507
US

IV. Provider business mailing address

129 EDGEWOOD RD
ARDMORE PA
19003-2507
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-6847
  • Fax:
Mailing address:
  • Phone: 610-649-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-038019-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: