Healthcare Provider Details

I. General information

NPI: 1396795829
Provider Name (Legal Business Name): MICHAEL J YEAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 THORNDALE RD
BREINIGSVILLE PA
18031-1277
US

IV. Provider business mailing address

1612 THORNDALE RD
BREINIGSVILLE PA
18031-1277
US

V. Phone/Fax

Practice location:
  • Phone: 610-657-3351
  • Fax:
Mailing address:
  • Phone: 610-657-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA10755700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD425256
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD425256
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD425256
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: