Healthcare Provider Details

I. General information

NPI: 1861981318
Provider Name (Legal Business Name): DAVID YARON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 ISLAND AVE STE DANDE
PHILADELPHIA PA
19153-2300
US

IV. Provider business mailing address

2821 ISLAND AVE STE DANDE
PHILADELPHIA PA
19153-2300
US

V. Phone/Fax

Practice location:
  • Phone: 215-863-6110
  • Fax: 215-863-6111
Mailing address:
  • Phone: 215-863-6110
  • Fax: 215-863-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD472645
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: