Healthcare Provider Details

I. General information

NPI: 1790854073
Provider Name (Legal Business Name): JOEL EUGENE YEAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 SCHAEFFER RD
NEWMANSTOWN PA
17073-7023
US

IV. Provider business mailing address

1297 SCHAEFFER RD
NEWMANSTOWN PA
17073-7023
US

V. Phone/Fax

Practice location:
  • Phone: 717-949-4138
  • Fax: 717-949-4140
Mailing address:
  • Phone: 717-949-4138
  • Fax: 717-949-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD430373
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD430373
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: