Healthcare Provider Details

I. General information

NPI: 1144285792
Provider Name (Legal Business Name): YIN KEONG NGEOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 FAIRWAY DR W
FAYETTEVILLE PA
17222-9236
US

IV. Provider business mailing address

6307 FAIRWAY DR W
FAYETTEVILLE PA
17222-9236
US

V. Phone/Fax

Practice location:
  • Phone: 717-352-7576
  • Fax: 717-352-4030
Mailing address:
  • Phone: 717-352-7576
  • Fax: 717-352-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD028643E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0024913
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number42315
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: