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General NPI Number Information
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NPI Number | 1689105165
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Entity Type | Organization
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Legal Business Name | DR.CHARLES YEAGER LLC
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 1 MASONIC DR
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-2199
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Country | US
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Telephone | 717-367-1121
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Fax | 717-361-4525
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Provider Business Mailing Address
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Address Line | 29 CLOISTER AVE
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City | EPHRATA
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State | PA
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Zip | 17522-1701
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Country | US
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Telephone | 717-733-5556
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Fax | 717-721-8139
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. CHARLES SCOTT YEAGER IV
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Credential | DPM
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Telephone | 717-475-1455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | SC002211L
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License Number State | PA
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