Provider Demographics
NPI:1376606541
Name:YACONO, CHRISTIAN SCOTT (MHS PAC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:SCOTT
Last Name:YACONO
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Gender:M
Credentials:MHS PAC
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-462-7100
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1129
Practice Address - Country:US
Practice Address - Phone:610-259-0240
Practice Address - Fax:610-259-0606
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-04-09
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Provider Licenses
StateLicense IDTaxonomies
PAMA051570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant