Healthcare Provider Details

I. General information

NPI: 1407856628
Provider Name (Legal Business Name): RICHARD YELOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 JOHN YOUNG WAY
EXTON PA
19341-2557
US

IV. Provider business mailing address

PO BOX 30560
LOS ANGELES CA
90030-0560
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-5550
  • Fax: 610-524-5546
Mailing address:
  • Phone: 610-524-5550
  • Fax: 610-524-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD027613E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: