MEDICARE: GARY YEOMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS005802L	PA

General Provider Information

NPI Number	:	1962430314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY YEOMAN D.O.

Provider Business Mailing Address
First Line	:	2500 MARYLAND RD STE 504
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1226
Country	:	US
Telephone Number	:	215-481-6836
Fax Number	:	215-481-6836

Provider Business Practice Location Address
First Line	:	9501 ROOSEVELT BLVD STE 206B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1027
Country	:	US
Telephone Number	:	215-671-8900
Fax Number	:	215-671-1272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/06/2020

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