Provider Demographics
NPI:1962461772
Name:YEAGER, LUANNE DERSTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUANNE
Middle Name:DERSTINE
Last Name:YEAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 SCHAEFFER RD
Mailing Address - Street 2:HERITAGE FAMILY HEALTH, PC
Mailing Address - City:NEWMANSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17073-7023
Mailing Address - Country:US
Mailing Address - Phone:717-949-4138
Mailing Address - Fax:717-949-4140
Practice Address - Street 1:1297 SCHAEFFER RD
Practice Address - Street 2:HERITAGE FAMILY HEALTH, PC
Practice Address - City:NEWMANSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17073-7023
Practice Address - Country:US
Practice Address - Phone:717-949-4138
Practice Address - Fax:717-949-4140
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1775088OtherBLUE SHIELD
PA50054560OtherBLUE CROSS
PA101445306Medicaid
PA50054560OtherBLUE CROSS
PA096296HE2Medicare ID - Type Unspecified