Provider Demographics
NPI:1295796811
Name:YEALY, MARGARET E (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:YEALY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:E
Other - Last Name:YEALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-262-2665
Mailing Address - Fax:717-267-0159
Practice Address - Street 1:22 ST PAUL DR STE 101
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1036
Practice Address - Country:US
Practice Address - Phone:717-262-2665
Practice Address - Fax:717-267-0159
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053263363A00000X, 363AM0700X
NH1012363A00000X
MDC0002783363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2044849OtherHIGHMARK BLUE SHIELD
PA103350874Medicaid
PA125905Medicare PIN
MDKL09I859Medicare PIN