Healthcare Provider Details

I. General information

NPI: 1285364398
Provider Name (Legal Business Name): MARY ALEXIS R. YANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 HUNTER HWY
TUNKHANNOCK PA
18657-8202
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-996-2700
  • Fax: 570-996-2711
Mailing address:
  • Phone: 570-996-2700
  • Fax: 570-996-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD491588
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: