Healthcare Provider Details

I. General information

NPI: 1750440996
Provider Name (Legal Business Name): ANDREW M YEAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7385 STONEY HILL LN
THE PLAINS VA
20198-2234
US

IV. Provider business mailing address

7385 STONEY HILL LN
THE PLAINS VA
20198-2234
US

V. Phone/Fax

Practice location:
  • Phone: 520-343-4995
  • Fax:
Mailing address:
  • Phone: 520-343-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number33451
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: