1720063845 NPI number — DANIEL QUENTON YEAGER MD

Table of content: DANIEL QUENTON YEAGER MD (NPI 1720063845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720063845 NPI number — DANIEL QUENTON YEAGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEAGER
Provider First Name:
DANIEL
Provider Middle Name:
QUENTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720063845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 N PRINCE ST
Provider Second Line Business Mailing Address:
APT 306
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-4612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-366-4606
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 GOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-250-0175
Provider Business Practice Location Address Fax Number:
570-366-5193
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  MD 044512L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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