Provider Demographics
NPI:1740710078
Name:YARRINGTON, SHANE ROBERT (DO)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:ROBERT
Last Name:YARRINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:ASPERS
Mailing Address - State:PA
Mailing Address - Zip Code:17304-9707
Mailing Address - Country:US
Mailing Address - Phone:717-677-4781
Mailing Address - Fax:717-677-4781
Practice Address - Street 1:2060 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:ASPERS
Practice Address - State:PA
Practice Address - Zip Code:17304-9707
Practice Address - Country:US
Practice Address - Phone:717-677-4781
Practice Address - Fax:717-677-4781
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS020925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103833075Medicaid
1740710078OtherNPI