Healthcare Provider Details

I. General information

NPI: 1548608433
Provider Name (Legal Business Name): MARGARET YESALAVAGE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST SUITE 210
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

833 CHESTNUT ST SUITE 210
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8420
  • Fax:
Mailing address:
  • Phone: 215-955-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberOT017439
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: