Healthcare Provider Details

I. General information

NPI: 1184825309
Provider Name (Legal Business Name): NATHAN YEASTED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 5TH AVE
CHAMBERSBURG PA
17201-4220
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-0629
  • Fax:
Mailing address:
  • Phone: 717-263-0629
  • Fax: 717-263-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD440292
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: