Provider Demographics
NPI:1679550479
Name:YEAGER, CHARLES S (DPM)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:YEAGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CLOISTER AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1701
Mailing Address - Country:US
Mailing Address - Phone:717-733-5556
Mailing Address - Fax:717-721-8139
Practice Address - Street 1:29 CLOISTER AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1701
Practice Address - Country:US
Practice Address - Phone:717-733-5556
Practice Address - Fax:717-721-8139
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002211L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1517151OtherGATEWAY
PA0005878970003Medicaid
PA01331201OtherCAPITAL BLUE CROSS
PA154506OtherHIGHMARK BLUE SHIELD
PA0005878970003Medicaid
PA154506JEQMedicare PIN
PA480011060Medicare PIN