=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871787952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G. ALAN YEASTED, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2007
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3515 WASHINGTON RD SUITE 570
-----------------------------------------------------
City | MC MURRAY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-3063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-572-6066
-----------------------------------------------------
Fax | 412-561-0785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3515 WASHINGTON RD SUITE 570
-----------------------------------------------------
City | MC MURRAY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-3063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-572-6066
-----------------------------------------------------
Fax | 412-561-0785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | G. ALAN YEASTED
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 412-572-6066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------