Healthcare Provider Details

I. General information

NPI: 1386349801
Provider Name (Legal Business Name): DOUGLAS MICHAEL YEAGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8640 SUDLEY RD STE 306
MANASSAS VA
20110-4404
US

IV. Provider business mailing address

8640 SUDLEY RD STE 306
MANASSAS VA
20110-4404
US

V. Phone/Fax

Practice location:
  • Phone: 703-330-3939
  • Fax: 703-331-0959
Mailing address:
  • Phone: 703-330-3939
  • Fax: 703-331-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102210105
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: