Provider Demographics
NPI:1932128170
Name:YEVELSON INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:YEVELSON INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEVELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-954-5575
Mailing Address - Street 1:65 E ELIZABETH AVE
Mailing Address - Street 2:SUITE 514
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6518
Mailing Address - Country:US
Mailing Address - Phone:610-954-5575
Mailing Address - Fax:610-954-9660
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 514
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6518
Practice Address - Country:US
Practice Address - Phone:610-954-5575
Practice Address - Fax:610-954-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006977L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3110406OtherAETNA
PA1468871OtherBLUE SHIELD
PA2153323001OtherIBC
PA50010442OtherCAPITAL
PA069633Medicare ID - Type Unspecified