Provider Demographics
NPI:1609928183
Name:DAVID L. YEAGER, MD
Entity Type:Organization
Organization Name:DAVID L. YEAGER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEDARD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-928-0815
Mailing Address - Street 1:346 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1871
Mailing Address - Country:US
Mailing Address - Phone:860-928-0815
Mailing Address - Fax:860-928-4514
Practice Address - Street 1:346 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1871
Practice Address - Country:US
Practice Address - Phone:860-928-0815
Practice Address - Fax:860-928-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001409363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03005Medicare ID - Type UnspecifiedMEDICARE GROUP#
CTP95481Medicare UPIN