Healthcare Provider Details

I. General information

NPI: 1184654543
Provider Name (Legal Business Name): TIMOTHY J YEAGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH STREET AND CIVIC CENTER BLVD CAA/ SUITE 9329
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

100 N 20TH ST CAA/ SUITE 200
PHILADELPHIA PA
19103-1443
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1858
  • Fax: 215-977-8351
Mailing address:
  • Phone: 215-977-8100
  • Fax: 215-977-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS005684L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberOS005684L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: