Healthcare Provider Details

I. General information

NPI: 1699956599
Provider Name (Legal Business Name): MARC ALAN YESTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 WASHINGTON RD SUITE 102
MC MURRAY PA
15317-3279
US

IV. Provider business mailing address

240 MOUNT LEBANON BLVD
PITTSBURGH PA
15234-1243
US

V. Phone/Fax

Practice location:
  • Phone: 724-969-5025
  • Fax: 724-969-5001
Mailing address:
  • Phone: 412-561-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number439235
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102504386-0003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: